NPIMap

Individual provider Active NPI

Brian K. Bonham, M.D.

  • Pediatrics Physician
  • Smithsburg, MD
National Provider Identifier
1366407975
Registry record updated Oct 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D0054451 Issued in MD
Practice address
22911 Jefferson Blvd
Smithsburg, MD 21783-1617
Phone
(301) 824-3343
Fax
(301) 824-6323
NPI assigned
Apr 18, 2006
Last updated
Oct 17, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D0054451 ME
Pediatrics Physician 208000000X D0054451 MD Primary

Addresses

Primary practice location

22911 Jefferson Blvd
Smithsburg, MD 21783-1617

Mailing address

22911 Jefferson Blvd
Smithsburg, MD 21783-1617
Phone (301) 824-3343

Other identifiers 1

IdentifierTypeStateIssuer
507200000MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20091229000385 MD Practitioner - Internal MedicinePractitioner - Pediatric Medicine 1153461975 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of North Carolina at Chapel Hill School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Meritus Medical Center IncGroup PAC ID 7113811795, 730 clinicians

Practice addresses (Care Compare)

11110 Medical Campus Rd
Hagerstown, MD 21742-6700

22911 Jefferson Blvd
Smithsburg, MD 21783-1617
Phone (301) 824-3343

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0054451MEMDInternal Medicine Physician
D0054451MDMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Meritus Urgent Care, LLC CurrentSince Oct 19, 2012 Accepting new patients
Meritus Medical Center Inc CurrentSince Jan 1, 2023 Accepting new patients
Meritus Medical Center Inc Current Accepting new patients
Medical Practices of Antietam, LLC CurrentSince Jul 1, 2001 Accepting new patients
Meritus Medical Center Inc CurrentSince Jan 1, 2023 Accepting new patients
Medical Practices of Antietam LLC CurrentSince Jul 1, 2001 Accepting new patients
Meritus Urgent Care LLC CurrentSince Oct 19, 2012 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Meritus Medical Laboratory LLC Past Accepting new patients
Meritus Medical Center Inc Past Accepting new patients

Locations

11110 Medical Campus Rd
Ste 229
Hagerstown, MD 21742
Phone (301) 665-4500

11116 Medical Campus Rd
Hagerstown, MD 21742
Phone (301) 766-7600

11116 Medical Campus Rd
Ste 2810
Hagerstown, MD 21742
Phone (240) 313-9580

13620 Crayton Blvd
Hagerstown, MD 21742
Phone (240) 313-3100

22911 Jefferson Blvd
Smithsburg, MD 21783
Phone (301) 824-1711

3 Byrkit Dr
Williamsport, MD 21795
Phone (301) 582-1150

Organizations & group practices 10

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.

Hospital & facility affiliations 4

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": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381968000000",
    "number": "1366407975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22911 JEFFERSON BLVD",
            "city": "SMITHSBURG",
            "state": "MD",
            "postal_code": "217831617",
            "telephone_number": "301-824-3343",
            "fax_number": "301-824-6323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22911 JEFFERSON BLVD",
            "city": "SMITHSBURG",
            "state": "MD",
            "postal_code": "217831617",
            "telephone_number": "301-824-3343",
            "fax_number": "301-824-6323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONHAM",
        "first_name": "BRIAN",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2013-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ME",
            "license": "D0054451",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0054451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507200000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithsburg, MD

Sources for this page

Verify at the official NPI Registry.