Michael T Bontekoe, MS, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA16231 Issued in CA

Practice address

450 N Roxbury Dr Ste 400
Beverly Hills, CA 90210-4218

Phone

(243) 941-6104

Fax

(424) 394-1628

NPI assigned

Sep 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Roxbury Dermatology and Multispecialty Practice IncGroup PAC ID 5890026819, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Physician Assistant

State licenses

Practice roles

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.

• Roxbury Dermatology and Multispecialty Practice Inc

  • Dermatology Physician
  • Beverly Hills, CA
  • NPI 1982179065
  Medicare reassignment Care Compare group
• Cedars-Sinai Medical Center

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1639172372
  NPD (past)

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

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1124120902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 N ROXBURY DR STE 400",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902104218",
            "telephone_number": "424-394-1610",
            "fax_number": "424-394-1628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 N ROXBURY DR STE 400",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902104218",
            "telephone_number": "243-941-6104",
            "fax_number": "424-394-1628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONTEKOE",
        "first_name": "MICHAEL",
        "middle_name": "T",
        "credential": "MS, PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-02",
        "last_updated": "2020-11-02",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA16231",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "PA16231",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristi Bond, PPS
• Talia Bondelli
• Frank Bonelli, MD
• Boneti Plastic Surgery
• Cristiano Boneti, MD
• Heather Marie Booth, M.S.,CCC-A
• Biana Borchenko, FNP-BC
• Michael Charles Borenstein, D.D.S.
• Samantha Borenstein, DDS
• Boris Zaks, MD Inc

• Medical Physician Assistant in Beverly Hills, CA
• Providers in Beverly Hills, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; 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.