Mackenzie Brannon Bonilla Reyes, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-15028 Issued in NC

Practice address

1000 Blythe Blvd
Charlotte, NC 28203-5812

Phone

(704) 446-5185

Fax

(704) 446-0221

NPI assigned

May 4, 2024

Last updated

Jan 28, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mackenzie Brannon Gray Former name

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wake Forest Emergency ProvidersGroup PAC ID 7012819816, 497 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mbonillareyes2990353@carolinashealthcaresystem.direct-ci.com

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.

• Wake Forest Emergency Providers

  • Multi-Specialty Clinic/Center
  • Statesville, NC
  • NPI 1396216735
  Medicare reassignment Care Compare group NPD
• Carolinas Medical Center

  dba Atrium Health Levine Children's Gastroenterology

  • Obstetrics & Gynecology Physician
  • Charlotte, NC
  • NPI 1275774333
  Medicare reassignment
• Carolinas Physicians Network Inc

  dba Atrium Health Musculoskeletal Institute Orthopedics & Sports Medici

  • Orthopaedic Surgery Physician
  • Charlotte, NC
  • NPI 1437607686
  Medicare reassignment
• Carolinas Physicians Network Inc

  dba The Sanger Clinic

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Charlotte, NC
  • NPI 1477878890
  Medicare reassignment
• Carolinas Medical Center

  dba Atrium Health Women's Care Urogynecology and Pelvic Surgery

  • Obstetrics & Gynecology Physician
  • Concord, NC
  • NPI 1467790055

  Multi-Specialty

  NPD
• Carolinas Medical Center

  dba Atrium Health Pharmacy Kenilworth

  • Community/Retail Pharmacy
  • Charlotte, NC
  • NPI 1982710554
  NPD
• Carolinas Physicians Network Inc

  dba Atrium Health Diabetes Prevention

  • Endocrinology, Diabetes & Metabolism Physician
  • Charlotte, NC
  • NPI 1437038544

  Multi-Specialty

  NPD
• Carolinas Physicians Network Inc

  dba The Sanger Clinic

  • Cardiovascular Disease Physician
  • Mooresville, NC
  • NPI 1477878981

  Multi-Specialty

  NPD
• Carolinas Physicians Network Inc

  dba Atrium Health Primary Care Richfield Family Medicine

  • Family Medicine Physician
  • Richfield, NC
  • NPI 1558765313

  Multi-Specialty

  NPD

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

{
    "created_epoch": "1714780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738022400000",
    "number": "1073360277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 HOUSTON ST NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280253258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-446-5185",
            "fax_number": "704-446-0221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONILLA REYES",
        "first_name": "MACKENZIE",
        "middle_name": "BRANNON",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-04",
        "last_updated": "2025-01-28",
        "certification_date": "2025-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-15028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MACKENZIE",
            "last_name": "GRAY",
            "middle_name": "BRANNON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stephen Bert Bondy, PH.D.
• Elhanan Jerahmeel Bone, LMSW, LCSWA
• Joshua Richard Bone, PSS, CADC-R
• Tyshawna Boney
• Kristen Elena Bonghi, COTA/L
• Christopher Omar Bonilla, MSW, LCSWA
• David Bonilla, LA.C
• Michael Robert Bonisa, PA-C
• Bonita Hutchinson and Associates, PLLC
• Alexandra Chere-Trina Bonner, LCSW-A

• Physician Assistant in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.