NPIMap

Individual provider Active NPI

Bonnie Kaye Otto, PA-C

  • Physician Assistant
  • Leetsdale, PA
National Provider Identifier
1053428177
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA052252 Issued in PA
Practice address
Ov Shopping Center
Suite 2a
Leetsdale, PA 15056
Phone
(412) 741-2700
Fax
(412) 741-9766
NPI assigned
Aug 24, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA052252 PA Primary

Addresses

Primary practice location

Ov Shopping Center
Suite 2a
Leetsdale, PA 15056

Mailing address

305 Timber LN
Sewickley, PA 15143-8952
Phone (412) 749-9694

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080910000184 PA Practitioner - Physician Assistant 2264508506 Reassigns benefits to 1 organization
I20200504002067 MO Practitioner - Physician Assistant 2264508506 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Heart and Vascular LLCGroup PAC ID 8820016207, 112 clinicians

Practice addresses (Care Compare)

1326 S Service W Rd
Suite 30
Sullivan, MO 63080-2306
Phone (636) 239-2711

625 S New Ballas Rd
Saint Louis, MO 63141-8253

901 Patients 1St Dr
Suite 2500
Washington, MO 63090-4700
Phone (314) 251-1700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince May 18, 2020 Accepting new patients
Heritage Valley Multispecialty Group, Inc. CurrentSince Jan 25, 2010 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince May 18, 2020 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince May 18, 2020 Accepting new patients
Mercy Clinic Kids Gi, LLC Past Accepting new patients
Saint Luke's Physician Group Inc Past Accepting new patients
Mercy Hospitals East Communities Past Accepting new patients
Mercy Clinic Cardiovascular and Thoracic Surgery, LLC Past Accepting new patients
Mercy Clinic East Communities Past Accepting new patients

Locations

15740 South Outer 40 Rd
Chesterfield, MO 63017
Phone (636) 735-4268

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 320
Rolla, MO 65401
Phone (573) 458-6359

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

99 Buss Rd
Aliquippa, PA 15001
Phone (724) 378-6640

1000 Dutch Ridge Rd
Ofc
Beaver, PA 15009
Phone (724) 773-2014

2 Peartree Way
Beaver, PA 15009
Phone (724) 773-6802

500 Sharon Rd
Beaver, PA 15009
Phone (724) 728-7683

12 Quaker Village Shopping Ctr
Leetsdale, PA 15056
Phone (724) 773-4502

Interoperability endpoints

  • Direct secure messaging: bonnieotto@hvhs.allscriptsdirect.net

Organizations & group practices 10

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053428177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 TIMBER LN",
            "city": "SEWICKLEY",
            "state": "PA",
            "postal_code": "151438952",
            "telephone_number": "412-749-9694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "OV SHOPPING CENTER",
            "address_2": "SUITE 2A",
            "city": "LEETSDALE",
            "state": "PA",
            "postal_code": "15056",
            "telephone_number": "412-741-2700",
            "fax_number": "412-741-9766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTO",
        "first_name": "BONNIE",
        "middle_name": "KAYE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA052252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leetsdale, PA

Sources for this page

Verify at the official NPI Registry.