Bonnie Stamatis, MD Inc
Organization Active NPI Internal Medicine Physician · Sheffield Village, OH
NPI 1164576286 · NPPES record last updated Dec 6, 2022
Key facts
- NPI
- 1164576286
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 35064311 (OH)
- Legal business name
- BONNIE STAMATIS, MD INC
- Practice address
- 5077 Waterford Dr Ste 305
Sheffield Village, OH 44035-0705 - Phone
- (440) 365-4800
- NPI assigned
- Jan 23, 2007
- Organization subpart
- No
Authorized official
- Name
- Bonnie Stamatis, M.D.
- Title
- President
- Phone
- (440) 365-4800
Practitioners 1
-
Bonnie Stamatis, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D0958263 | Bonnie Stamatis MD Inc Lab | Certificate of waiver | Mar 14, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110608000071 | OH | Part B Supplier - Clinic/Group Practice | 2769669332 |
Receives reassigned benefits from 1 practitioner Practice locations: Sheffield Village, OH |
National Provider Directory
Locations
5077 Waterford Dr
Ste 305
Sheffield Village, OH 44035
Phone (440) 365-4800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | 35064311 | OH | Yes |
Addresses
Primary practice location
5077 Waterford Dr Ste 305
Sheffield Village, OH 44035-0705
Mailing address
860 E Broad St
Elyria, OH 44035-6542
Phone (440) 365-4800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0908281 | Medicaid | OH |
Other providers in Sheffield Village, OH
- Brian Lee Bennett
- Robert Jon Berkowitz
- Rebecca Terese Biro
- Mary Carpenter Boia
- Brittney Renee Bolton
- Amy Ann Bradbury
- Jessica Brake
- Jarod Bronstrup
- Dequan Artrell Brown
- Sarah Ashley Brown
All providers in Sheffield Village, OH · Internal Medicine Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.