Individual provider Active NPI

Boyann Bea Bonjean, NP

  • Family Nurse Practitioner
  • Merrillville, IN
National Provider Identifier
1376184010
Registry record updated Oct 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
28083687A Issued in IN
Practice address
8550 Broadway
Merrillville, IN 46410-7173
Phone
(219) 769-3550
Fax
(219) 769-2642
NPI assigned
Oct 3, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 28083687A IN Primary

Addresses

Primary practice location

8550 Broadway
Merrillville, IN 46410-7173

Mailing address

1243 Surrey CT
Crown Point, IN 46307-5239
Phone (219) 682-6872

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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

Enrollment IDStateProvider typePAC IDDetails
I20200102000613 IN Practitioner - Nurse Practitioner 5991912602 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Elite Internal Medicine PCGroup PAC ID 5799857835, 2 clinicians

Practice addresses (Care Compare)

8550 Broadway
Suite C
Merrillville, IN 46410-7193
Phone (219) 769-3550

Hospital & facility affiliations

  • Methodist Hospitals Inc Hospital, Gary, IN, CCN 150002
  • Franciscan Health Crown Point Hospital, Crown Point, IN, CCN 150126

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28083687AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Elite Internal Medicine PC CurrentSince Dec 1, 2019 Accepting new patients
Mirich Medical Corporation PastSince Dec 1, 2019 Accepting new patients

Locations

8550 Broadway
Ste C
Merrillville, IN 46410
Phone (219) 769-3550

8550 Broadway
Merrillville, IN 46410
Phone (219) 736-8888

Organizations & group practices 2

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.

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": "1570060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1376184010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1243 SURREY CT",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463075239",
            "telephone_number": "219-682-6872",
            "fax_number": "219-769-2642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8550 BROADWAY",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464107173",
            "telephone_number": "219-769-3550",
            "fax_number": "219-769-2642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONJEAN",
        "first_name": "BOYANN",
        "middle_name": "BEA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-03",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28083687A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrillville, IN

Sources for this page

Verify at the official NPI Registry.