Bonnie P Ellenoff, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

051644 Issued in GA

Practice address

3640 Tramore Pointe Pkwy
Kaiser Permanente West Cobb Medical Center
Austell, GA 30106-6825

Phone

(770) 439-4700

Fax

(404) 370-0428

NPI assigned

Dec 13, 2006

Last updated

Jan 13, 2022By 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 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Family Practice

Education

Other, 1999

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Matrix Rehabilitation-Georgia IncGroup PAC ID 2567379498, shared by 4 NPIs, 40 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, 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.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Family Practice of Atlanta LLC

  • Primary Care Clinic/Center
  • Decatur, GA
  • NPI 1790966976
  NPD
• Piedmont Medical Care Corporation

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1912956046

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642032000000",
    "number": "1306907001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT RD NE",
            "address_2": "NINE PIEDMONT CENTER",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303051717",
            "telephone_number": "404-504-5678",
            "fax_number": "404-370-0428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3640 TRAMORE POINTE PKWY",
            "address_2": "KAISER PERMANENTE WEST COBB MEDICAL CENTER",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301066825",
            "telephone_number": "770-439-4700",
            "fax_number": "404-370-0428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLENOFF",
        "first_name": "BONNIE",
        "middle_name": "P",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "051644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009593950",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2525 Cumberland Pkwy SE",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303393915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Anthony Uba Ekwenchi, MD
• Fedoua Elhilali, PHARMD
• Erin Eliseo
• Elite EMS, LLC
• Douglas H Elleby, DPM
• Auburn Kyle Elliott
• Annisha Ellis, MD
• Elvin Home Care Inc
• Em Hearing and Screening
• Empowered Minds Behavioral

• Family Medicine Physician in Austell, GA
• Providers in Austell, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; 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.