Reagan Darice Novak Bonin, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD.207258 Issued in LA

Practice address

Charles Wilson Outpatient Clinic
2206 N John Redditt Dr
Lufkin, TX 75904

Phone

(936) 671-4300

Fax

(936) 671-4323

NPI assigned

Mar 22, 2011

Last updated

Oct 1, 2018By the provider in NPPES

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 LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northern Louisiana Emergency Physicians LLP

  dba Northern Louisiana Physicians LLP

  • Hospitalist Physician
  • Ruston, LA
  • NPI 1598995847
  Medicare reassignment NPD
• Northern Louisiana Emergency Physicians LLP

  dba Northern Louisiana Physicians LLP

  • Emergency Medicine Physician
  • Winnfield, LA
  • NPI 1497085690
  NPD
• Houston Vamc

  • Department of Veterans Affairs (VA) Pharmacy
  • Lufkin, TX
  • NPI 1528222551
  NPD (past)

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

{
    "created_epoch": "1300752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538352000000",
    "number": "1407155070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CHARLES WILSON OUTPATIENT VA CLINIC",
            "address_2": "2206 N JOHN REDDITT DR.",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "75904",
            "telephone_number": "369-671-4300",
            "fax_number": "936-671-4323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CHARLES WILSON OUTPATIENT CLINIC",
            "address_2": "2206 N JOHN REDDITT DR",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "75904",
            "telephone_number": "936-671-4300",
            "fax_number": "936-671-4323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONIN",
        "first_name": "REAGAN",
        "middle_name": "DARICE NOVAK",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-22",
        "last_updated": "2018-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "MD.207258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonnie Lynn Bodenstedt, OTR/L
• Ivonne Boeta, MD
• Audrey Katherine Bogue, RD
• Donald B Bogue, OD
• Kaydi Joa Boles, SLP
• Crystal Little Bonner, LPC
• John Byron Boone
• Robin Denise Borel, OT
• Dale Lynn Botsford, L.P.T.
• Jacob Terry Boudreaux, COTA

• Internal Medicine Physician in Lufkin, TX
• Providers in Lufkin, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.