Matthew Eugene Bonaventure, P.A-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0010-13048 Issued in NC

Practice address

231 N Judd Pkwy NE
Fuquay Varina, NC 27526-2694

Phone

(919) 235-6560

NPI assigned

Apr 4, 2012

Last updated

Apr 15, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

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, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Active Life Health of Cary PLLCGroup PAC ID 1355878190, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mbonaventure515413@directhisp.wakemed.org

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.

• Active Life Health of Cary PLLC

  dba Arthritis Knee Pain Centers

  • Physical Medicine & Rehabilitation Physician
  • Cary, NC
  • NPI 1477395960
  Medicare reassignment Care Compare group
• Flexogenix North Carolina PC

  • Diagnostic Radiology Physician
  • Charlotte, NC
  • NPI 1366826299
  Medicare reassignment NPD
• Doctors Urgent Care PLLC

  dba Carolina Urgent Care

  • Urgent Care Clinic/Center
  • Chapel Hill, NC
  • NPI 1003484734
  Medicare reassignment
• Wakemed Specialists Group, LLC

  • Cardiovascular Disease Physician
  • Raleigh, NC
  • NPI 1588227839
  Medicare reassignment
• Active Life Health of Cary PLLC

  dba Arthritis Knee Pain Centers

  • Durable Medical Equipment & Medical Supplies
  • Cary, NC
  • NPI 1053153551
  NPD
• Wakemed Specialists Group LLC

  dba WakeMed - Virtual Cardiac Rehab

  • Cardiac Rehabilitation Registered Nurse
  • Raleigh, NC
  • NPI 1063304228
  NPD
• Wakemed Specialists Group, LLC

  dba WakeMed Tobacco Cessation - Specialty

  • Internal Medicine Physician
  • Raleigh, NC
  • NPI 1801473087
  NPD

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

{
    "created_epoch": "1333497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1104182195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8701 FORESTER LN",
            "city": "APEX",
            "state": "NC",
            "postal_code": "275397965",
            "telephone_number": "516-477-6842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 N JUDD PKWY NE",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275262694",
            "telephone_number": "919-235-6560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONAVENTURE",
        "first_name": "MATTHEW",
        "middle_name": "EUGENE",
        "credential": "P.A-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-04",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-13048",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "016546",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-13048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Bloom
• Echo Blum, MSW, LCSW
• BN Healthcare, LLC (Brighton Manor)
• Jennifer L Bock
• Amanda Nicole Boling, MS, BCBA, LBA-NC
• Sabrina Borriello-Jones, LCSW
• John Andrew Bowman, PHARM.D.
• Isabel Grace Bradsher
• Daniel Lee Braun, PT
• Breastfeeding Support of the Triangle LLC

• Medical Physician Assistant in Fuquay Varina, NC
• Providers in Fuquay Varina, NC by specialty
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; 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.