Bonita J O'Reilly, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

47-04-102421 Issued in MI

Practice address

8191 Moorsbridge Rd Ste a
Portage, MI 49024-7417

Phone

(269) 312-8170

Fax

(269) 762-4785

NPI assigned

Aug 12, 2005

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2018 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1255333860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5110 STONEY BROOK RD",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490093846",
            "telephone_number": "269-372-3068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8191 MOORSBRIDGE RD STE A",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490247417",
            "telephone_number": "269-312-8170",
            "fax_number": "269-762-4785"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5110 Stoney Brook Rd",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490093846",
            "country_code": "US",
            "telephone_number": "269-377-2778",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'REILLY",
        "first_name": "BONITA",
        "middle_name": "J",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-12",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "47-04-102421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104545483",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104545456",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104545492",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104545465",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gina Marie O'Callaghan, PA-C
• Brittany O'Grady, BCBA
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• Kara Oates, DC
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• Ileana Oeschger
• Jean Lavonne Ogilvie, LLP

• Nurse Practitioner in Portage, MI
• Providers in Portage, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.