Nilah Nicole Bonham, O.D.
Individual provider Active NPI Optometrist · Brazil, IN
NPI 1275635534 · NPPES record last updated Jul 22, 2014
Key facts
- NPI
- 1275635534
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 18003365A (IN)
- Practice address
- 325 W National Avenue
Brazil, IN 47834 - Phone
- (812) 443-0060
- Fax
- (812) 446-5061
- NPI assigned
- Sep 5, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Indiana University - School of Optometry, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
325 W National Ave
Brazil, IN 47834-2542
Phone (812) 443-0060
Hospital & facility affiliations
- Ascension St Vincent Clay
Merit-based Incentive Payment System (MIPS)
- Final score
- 60 of 100
- Quality
- 30
- Promoting interoperability
- 95
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 25 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051003000615 | IN | Practitioner - Optometry | 7113952722 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18003365A | IN | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nilah Nicole Bonham OD PC | Optometrist | Current |
Accepting new patients |
| Nilah Nicole Bonham OD PC | Current |
Accepting new patients | |
| Darla Heck Sacopulos PC | Optometrist | Past | Accepting new patients |
| Eyecare Specialists | Optometrist | Past | Accepting new patients |
Locations
325 W National Ave
Brazil, IN 47834
Phone (812) 443-0060
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 18003365A | IN | Yes |
Addresses
Primary practice location
325 W National Avenue
Brazil, IN 47834
Mailing address
325 W National Avenue
Brazil, IN 47834
Phone (812) 443-0060
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 254870 | Other | IN | PTAN |
| 18003365A | Other | IN | LICENSE |
| 18003365B | Other | IN | INDIANA OLDPAC LIC. |
Other providers in Brazil, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2014. 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.
- Order and Referring (CMS).
- 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.