NPIMap

Individual provider Active NPI

Jackson Paul Bonfiglio, PA-C

  • Physician Assistant
  • Barberton, OH
National Provider Identifier
1053900159
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1182247 Issued in OH
Practice address
155 5TH St NE
Barberton, OH 44203-3332
Phone
(330) 615-3000
NPI assigned
Jan 13, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

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 1182247 OH Primary

Addresses

Primary practice location

155 5TH St NE
Barberton, OH 44203-3332

Mailing address

3713 Chesterton Dr
Toledo, OH 43615-1173
Phone (419) 708-4565

Other practice location 1

1 Park West Blvd
Akron, OH 44320-4218
Phone (815) 345-4677

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210204002565 OH Practitioner - Physician Assistant 1557775442 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1182247OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Metrohealth System CurrentSince Oct 29, 2024 Accepting new patients
The Metrohealth System Current Accepting new patients

Locations

2500 Metrohealth Dr
Cleveland, OH 44109
Phone (216) 778-2348

12301 Snow Rd
Parma Heights, OH 44130
Phone (216) 285-8810

Interoperability endpoints

  • Direct secure messaging: jbonfiglio21858@summahealth-direct.org
  • Direct secure messaging: jbonfiglio294025@direct.metrohealth.org

Organizations & group practices 24

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

View all 24

Hospital & facility affiliations 2

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

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Metrohealth System 1,150 clinicians

Practice addresses (Care Compare)

12301 Snow Rd
Parma, OH 44130-1002
Phone (216) 957-0700

2500 Metrohealth Dr
Cleveland, OH 44109-1900
Phone (216) 778-7800

2500 Metrohealth Dr
Cleveland, OH 44109-1998

Hospital & facility affiliations

  • Metrohealth System Hospital, Cleveland, OH, CCN 360059

NPI Registry JSON

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

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1053900159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3713 CHESTERTON DR",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436151173",
            "telephone_number": "419-708-4565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 5TH ST NE",
            "city": "BARBERTON",
            "state": "OH",
            "postal_code": "442033332",
            "telephone_number": "330-615-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Park West Blvd",
            "address_purpose": "LOCATION",
            "city": "Akron",
            "state": "OH",
            "postal_code": "443204218",
            "country_code": "US",
            "telephone_number": "815-345-4677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONFIGLIO",
        "first_name": "JACKSON",
        "middle_name": "PAUL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-13",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "1182247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Barberton, OH

Sources for this page

Verify at the official NPI Registry.