Charles Edward Bonfanti, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

75-PA002 Issued in NM

Practice address

630 Paseo del Pueblo Sur
Suite 150
Taos, NM 87571-6070

Phone

(575) 758-3005

Fax

(575) 758-7010

NPI assigned

Apr 28, 2006

Reactivated

Aug 3, 2007

Last updated

Feb 3, 2017By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in NM

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, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Practice Associates of TaosGroup PAC ID 4183521024, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Holy Cross Hospital a Div of Taos Health Systems Hospital, Taos, NM, CCN 321310

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: charles.bonfanti.1@2635.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/2635/brand/1/csg/1/fhir/r4

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.

• Family Practice Associates of Taos

  • Family Medicine Physician
  • Taos, NM
  • NPI 1881619864
  Medicare reassignment Care Compare group
• El Centro Family Health

  • Federally Qualified Health Center (FQHC)
  • Espanola, NM
  • NPI 1780689034
  Medicare reassignment NPD
• Family Practice Associates of Taos

  • Physiological Laboratory
  • Taos, NM
  • NPI 1407195233
  NPD
• El Centro Family Health

  • Federally Qualified Health Center (FQHC)
  • Wagon Mound, NM
  • NPI 1538324223
  NPD (past)
• Taos Health Systems, Inc., Holy Cross Hospital

  • Critical Access Hospital
  • Taos, NM
  • NPI 1902338049
  NPD (past)

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

• Taos Health Systems Inc Holy Cross Hospital

  dba Holy Cross Hospital

  • General Acute Care Hospital
  • Taos, NM
  • NPI 1194751958
  Care Compare affiliation
• Taos Health Systems, Inc., Holy Cross Hospital

  • Critical Access Hospital
  • Taos, NM
  • NPI 1902338049
  Care Compare affiliation

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486080000000",
    "number": "1295792570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 158",
            "address_2": "SUITE 150",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875320158",
            "telephone_number": "505-753-7218",
            "fax_number": "505-747-7396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 PASEO DEL PUEBLO SUR",
            "address_2": "SUITE 150",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "875716070",
            "telephone_number": "575-758-3005",
            "fax_number": "575-758-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONFANTI",
        "first_name": "CHARLES",
        "middle_name": "EDWARD",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-28",
        "last_updated": "2017-02-03",
        "deactivation_date": "2007-07-17",
        "reactivation_date": "2007-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "75-PA002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly A Boberschmidt, PHARMD
• Amber Bodhani, LPCC
• Nicholas Boeder, LCSW
• Emily Boeschenstein
• Sarah Bogar, CNM
• Adrienne Bonosevich
• Matthew E Borrego, PHD, MS, RPH
• Rifka Madrona Bourdeau, CPM, LM
• Bobbie Jeanette Boyd, L.M.,C.P.M.
• Pamela Elizabeth Boyleston, CRNA

• Physician Assistant in Taos, NM
• Providers in Taos, NM by specialty
• Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2017; 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.