Marie Susan Bonavoglia, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

OA002570 Issued in PA

Practice address

3 W Olive St
Scranton, PA 18508-2572

Phone

(570) 207-4054

Fax

(570) 207-4057

NPI assigned

Oct 18, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Marie Susan Gillette Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

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, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mbonavoglia101806@direct.geisinger.edu

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.

• Geisinger Clinic

  • Family Medicine Physician
  • Danville, PA
  • NPI 1366493868
  Medicare reassignment Care Compare group
• Geisinger Clinic

  • Diagnostic Radiology Physician
  • Danville, PA
  • NPI 1558313023
  NPD
• Geisinger Clinic

  • Family Medicine Physician
  • West Hazleton, PA
  • NPI 1902410673
  NPD
• Geisinger Clinic

  • Hospitalist Physician
  • Wilkes Barre, PA
  • NPI 1588614358
  NPD (past)

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

{
    "created_epoch": "1287360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608249600000",
    "number": "1245540731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144",
            "fax_number": "570-271-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 W OLIVE ST",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185082572",
            "telephone_number": "570-207-4054",
            "fax_number": "570-207-4057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONAVOGLIA",
        "first_name": "MARIE",
        "middle_name": "SUSAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-18",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA052473",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "OA002570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbonavoglia101806@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3 W Olive St",
            "city": "Scranton",
            "state": "PA",
            "country_code": "US",
            "postal_code": "185082572",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARIE",
            "last_name": "GILLETTE",
            "middle_name": "SUSAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sarah Bodnar, LCSW
• Mark William Bohn, M.D.
• Thomas S Boland, MD
• Jared Bomba
• Lori Bonafede
• Terri Lynn Bond, CDCES, NBC-HWC,
• Michael J. Bone, D.M.D.
• Kerri Louise Bonich
• Noelle Anne Bonitatis
• Lauren Elizabeth Bonitz

• Physician Assistant in Scranton, PA
• Providers in Scranton, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 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.