DR. BILLY BOLDON DO
NPI 1790754000
Pediatrics in Greenwood, MS
About Dr. Billy Boldon Do NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. BILLY BOLDON DO (NPI 1790754000) is an individual pediatrics provider in Greenwood, Mississippi, licensed in Mississippi (12903) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Billy Boldon Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Billy Boldon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Grenada, MS 38901
- Reassigned Medicare billing, Mississippi enrollment
- 1,932 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 38930 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 6
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
GREENWOOD, MS 38930
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Billy Boldon's NPI number?
The NPI number for Billy Boldon is 1790754000. It was assigned to this individual provider in the NPPES registry on March 17, 2006.
Where is Billy Boldon located?
Billy Boldon practices at 1405 Strong Ave, Greenwood, MS 38930. The listed phone number is (662) 459-7030.
What is Billy Boldon's specialty?
The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.
Is Billy Boldon enrolled in Medicare?
Yes. Billy Boldon is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Billy Boldon's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Billy Boldon reassigns Medicare benefits to State Of Mississippi-University Of Mississippi Medical Center (Grenada, MS). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Billy Boldon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Billy Boldon accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter of Alabama and Ambetter of Tennessee and 2 other insurers list Billy Boldon as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Billy Boldon was last updated on April 25, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dr. Billy Boldon, DO · NPI 1790754000
Pediatrics physician in Greenwood, Mississippi. Individual provider, active in the CMS NPPES registry since March 17, 2006.
## Identity
- **NPI:** 1790754000 (Entity type: Individual)
- **Enumerated:** March 17, 2006
- **Primary specialty:** Pediatrics · taxonomy 208000000X
- **State license:** 12903 (Mississippi)
- **Sole proprietor:** No
## Practice location
- **Address:** 1405 STRONG AVE, Greenwood, MS 38930-4035
- **Phone:** (662) 459-7030 · **Fax:** (662) 459-1104
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** State Of Mississippi-University Of Mississippi Medical Center (NPI 1932538527, Grenada, MS), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 25, 2008
- **Other identifiers:** Medicaid 00113949 (MS)
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Source: [NPI Profile](https://npiprofile.com/npi/1790754000) · Data from the CMS NPPES public registry.