Brian Keith Bonomo, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9101264 Issued in FL

Practice address

525 N Dacie PT
Lecanto, FL 34461-8399

Phone

(352) 746-2200

Fax

(352) 746-9320

NPI assigned

Aug 31, 2005

Last updated

Nov 12, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

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, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Suncoast Skin SolutionsGroup PAC ID 7416018221, 102 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• Direct secure messaging: brian.bonomo@suncoastskin.emadirect.md

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.

• Suncoast Skin Solutions

  • Dermatology Physician
  • Lutz, FL
  • NPI 1487827416
  Medicare reassignment Care Compare group
• Douglas K Pierce MD PA

  dba The Dermatology Clinic

  • Procedural Dermatology Physician
  • Largo, FL
  • NPI 1053515379
  NPD (past)

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668211200000",
    "number": "1124012596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4651 VAN DYKE RD",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335584880",
            "telephone_number": "813-321-1786",
            "fax_number": "813-321-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N DACIE PT",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344618399",
            "telephone_number": "352-746-2200",
            "fax_number": "352-746-9320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONOMO",
        "first_name": "BRIAN",
        "middle_name": "KEITH",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2022-11-12",
        "certification_date": "2022-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SRRGA",
            "identifier": "970015048",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290989800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Glenda Sue Bivona, FNP-BC
• BJ's Wholesale Club Inc.
• Brett Patrick Blake, M.D.
• Board of County Commissioners Citrus County (Citrus County, a Political Subdivision of the State of Florida)
• Ashley Danielle Boardman
• Shenevia Nichole Bostick
• Mary Beth Bottorf, APRN
• Timothy A Brant, M.D.
• Brashears Vital Care Corp (Brashear's Pharmacy)
• Megan Brecher, APRN

• Physician Assistant in Lecanto, FL
• Providers in Lecanto, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2022; 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.