Joshua Bonville, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

297873 Issued in NY

Practice address

725 East Adams St
4TH FL
Syracuse, NY 13210-2576

Phone

(315) 464-5831

Fax

(315) 464-2030

NPI assigned

Apr 12, 2016

Sex

Male

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 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jbonville34014@direct.upstate.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.

• Pediatric Service Group

  • Pediatrics Physician
  • Syracuse, NY
  • NPI 1770539066
  Medicare reassignment NPD

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

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684713600000",
    "number": "1295199545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 EAST ADAMS ST",
            "address_2": "4TH FL",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102576",
            "telephone_number": "315-464-5831",
            "fax_number": "315-464-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 EAST ADAMS ST",
            "address_2": "4TH FL",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102576",
            "telephone_number": "315-464-5831",
            "fax_number": "315-464-2030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONVILLE",
        "first_name": "JOSHUA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-12",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "297873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05704141",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Bond, CASAC- T 40177
• Lauren M Bonhomme, NP
• Christine E Bonilla, MSED
• Susan Donohue Bonomo, LCSW-R
• Tara Bonomo, SLP
• Angela D Booker, LPN
• Carla D. Booker
• Fronda Sheva Booker, LPN
• Shakeela Anisah Booker, FNP
• Debra A Booton, OD

• Pediatrics Physician in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.