Mary Bonvissuto, APRN

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

0024188379 Issued in VA

Practice address

11484 Washington PLZ W Ste 300
Reston, VA 20190-4342

Phone

(703) 443-2000

NPI assigned

Nov 30, 2023

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

Medicare fee-for-service enrollment

Enrolled in DC, VA, TN3 enrollments

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 3

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Capital Healthcare PCGroup PAC ID 3779723309, 102 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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 and National Provider Directory roles.

• Capital Healthcare PC

  • Primary Care Clinic/Center
  • Alexandria, VA
  • NPI 1811239627

  DC, VA

  Medicare reassignment Care Compare group NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  TN

  Medicare reassignment NPD
• Capital Healthcare PC Dba Allcare

  • Family Medicine Physician
  • Woodbridge, VA
  • NPI 1407162076
  NPD

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

{
    "created_epoch": "1701302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701302400000",
    "number": "1316713480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 9TH ST S APT 61A",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222042335",
            "telephone_number": "301-802-2450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11484 WASHINGTON PLZ W STE 300",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201904342",
            "telephone_number": "703-443-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONVISSUTO",
        "first_name": "MARY",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-30",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "VA",
            "license": "0024188379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy E Boles, DPT
• Katherine Julia Bolin, MA
• Cameron Bolinder
• Mary Bolton-Owens, L.P.C.
• Liliana Elizabeth Bonilla Hernandez, FNP-BC
• Elda A Bordon, DDS, MPH
• Kristopher Bosque
• Macy Reed Bosshard, PA-C
• Hayley Boucher, DPT
• Jacqueline Anne Boulris, PA-C

• All providers in Reston, VA
• Primary Care Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.
• 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.