Jonvanni Bongolan

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

19774 Issued in CA

Practice address

9300 Campus Point Dr
La Jolla, CA 92037-1300

Phone

(858) 657-6390

NPI assigned

Sep 2, 2010

Sex

Male

Sole proprietor

No

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 AK, TX2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Bethel Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Bethel, AK
  • NPI 1124078019

  AK

  Medicare reassignment NPD
• Maniilaq Association

  • Rural Acute Care Hospital
  • Kotzebue, AK
  • NPI 1861698805

  TX

  Medicare reassignment NPD
• Bethel Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Bethel, AK
  • NPI 1891279097
  NPD
• Maniilaq Association

  • Federal Public Health Clinic/Center
  • Kiana, AK
  • NPI 1255608998
  NPD
• Maniilaq Association

  • Critical Access Hospital
  • Kotzebue, AK
  • NPI 1316995210
  NPD

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

{
    "created_epoch": "1283385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291680000000",
    "number": "1124335807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4443 CHEROKEE AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921163610",
            "telephone_number": "619-884-9726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 CAMPUS POINT DR",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371300",
            "telephone_number": "858-657-6390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONGOLAN",
        "first_name": "JONVANNI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-02",
        "last_updated": "2010-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "19774",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "624546",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suresh Bollapragada
• Heather C. Bonaguidi, P.A.
• Robert A. Bonakdar, M.D.
• Kimberlee Ann Bond, OTR/L
• Bonebuilders Medical Clinic
• Carly Alissa Bonnell, M.S.W.
• Claire Webb Bonnyman
• Beata Myrrha Booth, LAC
• Stephanie Borden, DPT
• Gerald M. Bordin, M.D.

• All providers in La Jolla, CA
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.