Abram Richard Bonneville, PA-S

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7426 Issued in WI

Practice address

1409 Hazelwood Dr
Manitowoc, WI 54220-1607

Phone

(608) 843-6117

NPI assigned

Jun 12, 2023

Last updated

Jul 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

84.74 of 100Reported as group

Quality

73.23

Improvement activities

40

Cost

82.42

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Door County Memorial Hospital

  dba Door County Medical Center

  • Critical Access Hospital
  • Sturgeon Bay, WI
  • NPI 1093743874
  Medicare reassignment NPD
• Vituity-Wisconsin Em SC

  • Emergency Medicine Physician
  • Pleasant Prairie, WI
  • NPI 1326730664
  Medicare reassignment
• Door County Memorial Hospital

  dba DirectCare

  • Rural Health Clinic/Center
  • Sturgeon Bay, WI
  • NPI 1326748104
  NPD
• Vituity-Wisconsin Em SC

  • Emergency Medicine Physician
  • Oconto Falls, WI
  • NPI 1710754296
  NPD
• Vituity-Wisconsin Em SC

  • Emergency Medicine Physician
  • Green Bay, WI
  • NPI 1902673486
  NPD
• St Vincent Hospital-Hospital Sisters-Third Order of St Francis

  dba Prevea Health

  • General Practice Physician
  • Green Bay, WI
  • NPI 1285613638
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1003590027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 HAZELWOOD DR",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542201607",
            "telephone_number": "608-843-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 HAZELWOOD DR",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542201607",
            "telephone_number": "608-843-6117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONNEVILLE",
        "first_name": "ABRAM",
        "middle_name": "RICHARD",
        "credential": "PA-S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "7426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia A Boldt, PTA
• Shannon Marie Bolick
• Lori A Bonin, PT
• Michael Bonin
• Nicole Bonin, MSW, LCSW
• Brian L Boomgarden, MS CADC
• Justine Boonperm
• Katherine Borchardt, RN
• Elise Borja, DDS
• Nathan Borlee

• Physician Assistant in Manitowoc, WI
• Providers in Manitowoc, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.