Individual provider Active NPI

Rachael Bonawitz, MD

  • Pediatrics Physician
  • Philadelphia, PA
National Provider Identifier
1023332798
Registry record updated Sep 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD465379 Issued in PA
Practice address
160 E Erie Ave
Philadelphia, PA 19134-1011
Phone
(215) 427-3750
Fax
(215) 427-4316
NPI assigned
Mar 24, 2010
Last updated
Sep 12, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X MD465379 PA Primary

Addresses

Primary practice location

160 E Erie Ave
Philadelphia, PA 19134-1011

Mailing address

1 Boston Medical Ctr PL
Boston, MA 02118-2908
Phone (617) 638-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181009002823 PA Practitioner - Pediatric Medicine 2769609304 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD465379PAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
STC Pediatrics LLC Pediatrics CurrentSince Dec 1, 2019 Accepting new patients
STC Pediatrics LLC Pediatrics CurrentSince Dec 1, 2019 Accepting new patients
STC Pediatrics LLC Pediatrics Current Accepting new patients

Locations

153 Brodhead Rd
Bethlehem, PA 18017
Phone (484) 526-3200

160 E Erie Ave
Philadelphia, PA 19134
Phone (215) 427-4067

300 E Hunting Park Ave
Philadelphia, PA 19124
Phone (215) 427-8363

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1269388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536710400000",
    "number": "1023332798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BOSTON MEDICAL CTR PL",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182908",
            "telephone_number": "617-638-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 E ERIE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191341011",
            "telephone_number": "215-427-3750",
            "fax_number": "215-427-4316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONAWITZ",
        "first_name": "RACHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-24",
        "last_updated": "2018-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD465379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.