Bonnie Caukins Revelle, MD

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

License

0101240729 Issued in VA

Practice address

601 Childrens LN
Norfolk, VA 23507-1910

Phone

(757) 668-7456

Fax

(757) 668-9255

NPI assigned

May 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Childrens Specialty Group PLLC

  • Pediatrics Physician
  • Norfolk, VA
  • NPI 1255354130
  NPD (past)

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589414400000",
    "number": "1225087349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 REDGATE AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071515",
            "telephone_number": "757-668-7007",
            "fax_number": "757-668-8658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 CHILDRENS LN",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071910",
            "telephone_number": "757-668-7456",
            "fax_number": "757-668-9255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVELLE",
        "first_name": "BONNIE",
        "middle_name": "CAUKINS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-08",
        "last_updated": "2020-05-14",
        "certification_date": "2020-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101240729",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "27288",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "VA",
            "license": "0101240729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8971295",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "71295",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890160M",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Retina & Vitreous Center PC (Wagner Kapoor Institute)
• Retina Group of Tidewater PC
• Retinal Consultants Inc (mark j mccarthy md)
• Christopher Raphael Rettenmaier, MD
• Nicholas Battista Rettenmaier, MD
• Revitalize Behavioral Services, LLC
• Revitalize Function LLC
• Rewired Canvas Psychotherapy LLC
• Amber Lynn Reyes, PA
• James Reyes

• Neonatal-Perinatal Medicine Physician in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Neonatal-Perinatal Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.