Si M Bong

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

024591 Issued in NY

Practice address

3916 Prince St Ste 251
Flushing, NY 11354-5367

Phone

(718) 886-3877

NPI assigned

Mar 4, 2020

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 NY

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, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Mark Ilyagu Medical PC

  • Internal Medicine Physician
  • Valley Stream, NY
  • NPI 1619699915
  Medicare reassignment NPD

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

{
    "created_epoch": "1583280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583280000000",
    "number": "1366077968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13811 63RD AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113671105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3916 PRINCE ST STE 251",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113545367",
            "telephone_number": "718-886-3877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONG",
        "first_name": "SI",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-04",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "024591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chanah Boiangiu
• Sze Wan Bok, AUD
• Bokyung Kim LCSW, PLLC
• Boling Pharmacy Inc
• Chantelle Bombardier
• Wai Loon Bong, PA
• Cassandra Bonilla
• Alexis Bonner, FNP-BC
• Marie Regine Bony Normil
• Booth Medical Associates PC

• Physician Assistant in Flushing, NY
• Providers in Flushing, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2020; 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.