Michelle D Bonta, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD25129 Issued in OR

Practice address

417 SW 117TH Ave
2ND Floor
Portland, OR 97225-5924

Phone

(503) 216-9400

Fax

(503) 216-9499

NPI assigned

Jun 25, 2006

Last updated

Oct 15, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Harvard Medical School, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Health and Services OregonGroup PAC ID 0648183608, 1,423 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Portland Medical Center Hospital, Portland, OR, CCN 380061

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Providence Health & Services Oregon

  dba Providence Medical Group

  • General Practice Physician
  • Lake Oswego, OR
  • NPI 1023488343
  Medicare reassignment Care Compare group NPD
• Providence Health & Services Oregon

  dba Providence Medical Group

  • Psychiatry Physician
  • Portland, OR
  • NPI 1760177737
  NPD
• Providence Health & Services Oregon

  dba Providence Medical Group

  • Internal Medicine Physician
  • Oregon City, OR
  • NPI 1992138309
  NPD
• Providence Health & Services - Oregon

  dba Providence Medical Group

  • Internal Medicine Physician
  • Sherwood, OR
  • NPI 1184729329
  NPD (past)

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

• Providence Health & Services - Oregon

  dba Providence Portland Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1003991845
  Care Compare affiliation
• Providence Health & Services - Oregon

  • Case Manager/Care Coordinator
  • Portland, OR
  • NPI 1891822995

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1265468615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494",
            "fax_number": "503-215-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 SW 117TH AVE",
            "address_2": "2ND FLOOR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255924",
            "telephone_number": "503-216-9400",
            "fax_number": "503-216-9499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONTA",
        "first_name": "MICHELLE",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-25",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "MD25129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE - PH&S",
            "identifier": "P00207043",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "233462",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbonta101874@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "417 SW 117th Ave",
            "address_2": "2nd Floor",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972255924",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Paul Matthew Bonney, MD
• Christopher Michael Bonnichsen, LAC MAOAM
• Jenna Bonnichsen
• Sandra Bonnie
• Bonny Seal (Cypress Family Health)
• Alexander Harmon Bonte, MB, BCH, BAO
• Erin Marie Murchan Bonura, MD
• Sophie Bonzi
• Kara Mardae Book, OT
• Michael Booker, MD

• Dermatology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Dermatology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.