NPIMap

Individual provider Active NPI

Bonnie C Carter, MD

  • Family Medicine Physician
  • Odessa, TX
National Provider Identifier
1063417632
Registry record updated Oct 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L5693 Issued in TX
Practice address
1940 E 42ND St
Odessa, TX 79762-5840
Phone
(432) 640-6712
Fax
(432) 640-4788
NPI assigned
Jun 20, 2005
Reactivated
Jun 12, 2006
Last updated
Oct 19, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 19, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L5693 TX Primary

Addresses

Primary practice location

1940 E 42ND St
Odessa, TX 79762-5840

Mailing address

PO Box 2129
Odessa, TX 79760-2129
Phone (432) 640-6712

Other practice location 1

421 E 1st St
Dumas, TX 79029-3201
Phone (806) 935-5094

Other identifiers 1

IdentifierTypeStateIssuer
168174411MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20040826000173 TX Practitioner - Family Practice 5092789800 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas Tech University Health Science Center School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Big Bend Medical GroupGroup PAC ID 2163326281, 46 clinicians

Practice addresses (Care Compare)

1608 W FM
Big Spring, TX 79720-4113

1608 W FM 700
Big Spring, TX 79720-4113

7101 Eastridge Rd
Odessa, TX 79765-8919
Phone (432) 550-0048

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Scotty Ortega MD LLP Family Medicine CurrentSince Mar 10, 2024 Accepting new patients
Big Bend Medical Group CurrentSince Oct 16, 2024 Accepting new patients
Big Bend Medical Group Family Medicine CurrentSince Oct 16, 2024 Accepting new patients
Benjamin W. Covington, M.D., P.a. Family Medicine Past Accepting new patients
Canadian River Emergency Physicians PLLC Past Accepting new patients
Seminole Hospital District of Gaines County Texas Past Accepting new patients
Texas Emergency Room Services PA Past Accepting new patients

Locations

1608 W FM 700
Ste C
Big Spring, TX 79720
Phone (432) 263-7700

3001 N Faudree Rd
Odessa, TX 79765
Phone (432) 332-1386

500 W 4th St
Odessa, TX 79761
Phone (432) 640-1000

7101 Eastridge Rd
Odessa, TX 79765
Phone (432) 550-0048

980 E 87th St
Ste D
Odessa, TX 79765
Phone (432) 332-1770

Interoperability endpoints

  • Direct secure messaging: bonnie.carter.1@1603.direct.athenahealth.com

Organizations & group practices 7

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 4

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": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508371200000",
    "number": "1063417632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2129",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797602129",
            "telephone_number": "432-640-6712",
            "fax_number": "432-640-4788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1940 E 42ND ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797625840",
            "telephone_number": "432-640-6712",
            "fax_number": "432-640-4788"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "421 E 1st St",
            "address_purpose": "LOCATION",
            "city": "Dumas",
            "state": "TX",
            "postal_code": "790293201",
            "country_code": "US",
            "telephone_number": "806-935-5094",
            "fax_number": "806-935-3990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARTER",
        "first_name": "BONNIE",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-20",
        "last_updated": "2017-10-19",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L5693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168174411",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

Verify at the official NPI Registry.