Michael Boniello, M.D., M.SC.
Individual provider Active NPI Sports Medicine (Orthopaedic Surgery) Physician · Rocky Hill, CT
NPI 1023469293 · NPPES record last updated May 15, 2023
Key facts
- NPI
- 1023469293
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X
- License
- 70647 (CT)
- Practice address
- 1111 Cromwell Ave Ste 404
Rocky Hill, CT 06067-3455 - Phone
- (860) 525-4469
- NPI assigned
- Jun 28, 2016
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Orthopedic Surgery
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Orthopedic Surgical Partners, P.C.
McLean Fund
Practice addresses (Care Compare)
1111 Cromwell Ave
Suite 404
Rocky Hill, CT 06067-3455
Phone (860) 525-4469
75 Great Pond Rd
Simsbury, CT 06070-1980
Hospital & facility affiliations
- St Francis Hospital & Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Hip replacement | 1-10 |
| Lower limb (leg) arthroscopy (minimally invasive joint repair) | 1-10 |
| Upper limb (arm) arthroscopy (minimally invasive joint repair) | 1-10 |
| Removal of tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220824001945 | CT | Practitioner - Orthopedic Surgery |
9234512211 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthopedic Surgical Partners, PC | Multi-Specialty | Current |
Accepting new patients |
| Orthopedic Surgical Partners, P.C. | Multi-Specialty | Current |
Accepting new patients |
Locations
31 Ensign Dr
Avon, CT 06001
Phone (860) 409-9125
277 Middle Tpke W
Manchester, CT 06040
Phone (860) 432-4640
1111 Cromwell Ave
Ste 404
Rocky Hill, CT 06067
1111 Cromwell Ave
Ste 403
Rocky Hill, CT 06067
5 Founders St
Ste 202
Willimantic, CT 06226
Phone (860) 456-3997
Interoperability endpoints
- mboniello452447@xdr.hhchealthdirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | 70647 | CT | |
| Sports Medicine (Orthopaedic Surgery) Physician | 207XX0005X | 70647 | CT | Yes |
Addresses
Primary practice location
1111 Cromwell Ave Ste 404
Rocky Hill, CT 06067-3455
Mailing address
1111 Cromwell Ave Ste 404
Rocky Hill, CT 06067-3455
Phone (860) 525-4469
Other providers in Rocky Hill, CT
- Robert Dariusz Bogacki
- Jessica Boland
- Danielle Boley
- Beth Bonaiuto
- Thomas A Bondarchuk
- Holly B Bradley
- Dalia Raquel Broderick
- Sarah Brooks
- Amy E Bruce
- Karen Bruck
All providers in Rocky Hill, CT · Sports Medicine (Orthopaedic Surgery) Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.