NPIMap

Individual provider Active NPI

Dustin Lee Bonzo, MD

  • Family Medicine Physician
  • Frontenac, KS
National Provider Identifier
1154884799
Registry record updated Jul 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
04-44000 Issued in KS
Practice address
1011 N Highway 69
Frontenac, KS 66763-8100
Phone
(620) 235-1377
NPI assigned
Apr 10, 2019
Last updated
Jul 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 04-44000 KS Primary

Addresses

Primary practice location

1011 N Highway 69
Frontenac, KS 66763-8100

Mailing address

302 N Hospital Dr
Girard, KS 66743-2000
Phone (620) 724-8291

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210901003193 KS Practitioner - Family Practice 0345574489 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kansas School of Med (KC/Wich/Sal), 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospital District No 1 Crawford CountyGroup PAC ID 3476464538, shared by 11 NPIs, 22 clinicians

Practice addresses (Care Compare)

1011 N 69 Hwy
Frontenac (Pittsburg), KS 66763-8100
Phone (620) 235-1377

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
04-44000KSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital District No 1 Crawford County Family Medicine CurrentSince Sep 13, 2021 Accepting new patients
Hospital District No 1 Crawford County CurrentSince Sep 13, 2021 Accepting new patients
Hospital District No 1 Crawford County Current Accepting new patients
Hospital District No 1 Crawford County Family Medicine Past Accepting new patients
Medicalodges, Inc. Past Accepting new patients

Locations

419 E Washington St
Arma, KS 66712
Phone (620) 347-4711

120 NW 400 Hwy
Cherokee, KS 66724
Phone (620) 457-8101

109 S Main St
Fort Scott, KS 66701
Phone (620) 223-7008

302 N Hospital Dr
Girard, KS 66743
Phone (620) 724-8291

307 N Hospital Dr
Ste 5
Girard, KS 66743
Phone (620) 724-4659

401 5th St
Uniontown, KS 66779
Phone (620) 724-8291

Organizations & group practices 5

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1554854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659052800000",
    "number": "1154884799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 N HOSPITAL DR",
            "city": "GIRARD",
            "state": "KS",
            "postal_code": "667432000",
            "telephone_number": "620-724-8291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 N HIGHWAY 69",
            "city": "FRONTENAC",
            "state": "KS",
            "postal_code": "667638100",
            "telephone_number": "620-235-1377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONZO",
        "first_name": "DUSTIN",
        "middle_name": "LEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-10",
        "last_updated": "2022-07-29",
        "certification_date": "2022-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-44000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frontenac, KS

Sources for this page

Verify at the official NPI Registry.