NPIMap

Individual provider Active NPI

Mark W Bonneville, MD

  • Emergency Medicine Physician
  • Monticello, MN
National Provider Identifier
1336129626
Registry record updated Jan 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
35582 Issued in MN
Practice address
1013 Hart Blvd
Monticello, MN 55362-8575
Phone
(763) 271-2386
Fax
(763) 271-2890
NPI assigned
Jan 20, 2006
Last updated
Jan 15, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 35582 MN Primary

Addresses

Primary practice location

1013 Hart Blvd
Monticello, MN 55362-8575

Mailing address

12955 30TH Ave N
Plymouth, MN 55441-2738
Phone (763) 553-1070

Other identifiers 1

IdentifierTypeStateIssuer
069268900MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051202000162 MN Practitioner - Emergency Medicine 7315967585 Reassigns benefits to 11 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Saint Louis University School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4300 Marketpointe Dr
Suite 100
Bloomington, MN 55435-5435
Phone (952) 835-9880

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Carris Health LLC Emergency Medicine CurrentSince Apr 1, 2021 Accepting new patients
Centracare Health System - Long Prairie CurrentSince Aug 1, 2020 Accepting new patients
Centracare Health System-NR LLC CurrentSince Apr 1, 2013 Accepting new patients
Carris Health LLC CurrentSince Apr 1, 2021 Accepting new patients
Astera Health Current Accepting new patients
Centracare Health System - Sauk Centre CurrentSince Jun 1, 2023 Accepting new patients
Centracare Health System-NR LLC Current Accepting new patients
Centracare Health System - Sauk Centre CurrentSince Jun 1, 2023 Accepting new patients
Centracare Health System - Melrose CurrentSince Jun 1, 2018 Accepting new patients
Centracare Health System - Melrose CurrentSince Jun 1, 2018 Accepting new patients
Centracare Health System - Sauk Centre CurrentSince Dec 1, 2025 Accepting new patients
Emergency Physicians Professional Association CurrentSince Mar 15, 2023 Accepting new patients
Emergency Physicians Professional Association Emergency Medicine CurrentSince Mar 15, 2023 Accepting new patients
Centracare Health System-NR LLC CurrentSince Apr 1, 2013 Accepting new patients

Locations

50 Centracare Dr
Long Prairie, MN 56347
Phone (320) 732-2131

525 Main St W
Melrose, MN 56352
Phone (320) 256-4228

4300 Marketpointe Dr
Ste 100
Minneapolis, MN 55435
Phone (952) 767-4574

1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

425 Elm St N
Sauk Centre, MN 56378
Phone (320) 352-2221

301 Becker Ave SW
Willmar, MN 56201
Phone (320) 231-4120

Interoperability endpoints

  • Direct secure messaging: mbonneville21928@direct.centracare.com

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231977600000",
    "number": "1336129626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12955 30TH AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412738",
            "telephone_number": "763-553-1070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 HART BLVD",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553628575",
            "telephone_number": "763-271-2386",
            "fax_number": "763-271-2890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONNEVILLE",
        "first_name": "MARK",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2009-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "35582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "069268900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monticello, MN

Sources for this page

Verify at the official NPI Registry.