DR. DOUGLAS BOLDA (M.D.) – Orthopaedic Surgery Physician, NPI 1174519458
Orthopaedic Surgery Physician
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NPPES metrics only — not quality of care.
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Provider Addresses for DR. DOUGLAS BOLDA (M.D.)
1234, East Dupont Road, Fort Wayne, Allen County, Indiana, 46825, United States
SUITE 1
FORT WAYNE, IN 468251545
Phone: (260) 373-9700
Fax: (260) 373-9740
Type: Mailing
Sawyer Road, Kendallville, Noble County, Indiana, 46755, United States
SUITE B
KENDALLVILLE, IN 467552568
Phone: (260) 347-8340
Fax: (260) 347-8435
Type: Location
401 N Sawyer Rd
Suite B
Kendallville, IN 467552568
Phone: (260) 347-8340
Fax: (260) 347-8435
Type: Location
1626 Tuttle St
Baraboo, WI 539131501
Phone: (608) 355-6868
Fax: (608) 355-6810
Type: Location
155 Zinnia Ct
Driftwood, TX 786195704
Phone: (618) 980-3619
Type: Location
PO BOX 781076 SUITE 1
DETROIT, MI 482781076
Phone: (317) 528-4800
Fax: (317) 865-1479
Type: Mailing
3500 FRANCISCAN WAY
MICHIGAN CITY, IN 463600021
Phone: (219) 879-8511
Fax: (219) 933-2288
Type: Location
PO BOX 38
CORYDON, IN 471120038
Phone: (812) 738-4251
Type: Mailing
1263 HOSPITAL DR NW STE 105
CORYDON, IN 471122173
Phone: (812) 738-4251
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-02-08
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20060306000738 | I | Orthopedic Surgery | IN | TBD |
| I20221028001163 | I | Orthopedic Surgery | TX | TBD |
| I20230208003318 | I | Orthopedic Surgery | WI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 46825)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| ORTHOPEDIC SURGERY | IN | 20610 | Aspiration and/or injection of large joint or joint capsule | 42 | 31 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Marriage And Family Therapist | TN | |
| Physician Assistant | IA | |
| General Surgery | IA | |
| Family Practice | IA | |
| Nurse Practitioner | IA | |
| Nurse Practitioner | IA | |
| Family Practice, Emergency Medicine | GA | |
| Nurse Practitioner | IA | |
| Physician Assistant | IA | |
| Physician Assistant | IA |
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