Charles Edward Bonfanti, PA
Individual provider Active NPI Physician Assistant · Taos, NM
NPI 1295792570 · NPPES record last updated Feb 3, 2017
Key facts
- NPI
- 1295792570
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 75-PA002 (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
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1975
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Family Practice Associates of Taos
Practice addresses (Care Compare)
630 Paseo del Pueblo Sur
Suite 150
Taos, NM 87571-7002
Phone (505) 758-3005
Hospital & facility affiliations
- Holy Cross Hospital a Div of Taos Health Systems
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090504000060 | NM | Practitioner - Physician Assistant | 7517015498 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| El Centro Family Health | Current |
Accepting new patients | |
| Family Practice Associates of Taos | Current |
Accepting new patients | |
| El Centro Family Health | Past | Accepting new patients | |
| Taos Health Systems, Inc., Holy Cross Hospital | Past | Accepting new patients |
Locations
630 Paseo del Pueblo Sur
Ste 150
Taos, NM 87571
Phone (505) 758-3005
Interoperability endpoints
- charles.bonfanti.1@2635.direct.athenahealth.com
- https://api.platform.athenahealth.com/2635/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 75-PA002 | NM | Yes |
Addresses
Primary practice location
630 Paseo del Pueblo Sur
Suite 150
Taos, NM 87571-6070
Mailing address
PO Box 158
Suite 150
Espanola, NM 87532-0158
Phone (505) 753-7218
Other providers in Taos, NM
- Kimberly A Boberschmidt
- Amber Bodhani
- Nicholas Boeder
- Emily Boeschenstein
- Sarah Bogar
- Adrienne Bonosevich
- Matthew E Borrego
- Rifka Madrona Bourdeau
- Bobbie Jeanette Boyd
- Pamela Elizabeth Boyleston
All providers in Taos, NM · Physician Assistant in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2017. 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.