NPIMap

Individual provider Active NPI

Eventure Duldulao Bernardino, MD

  • Family Medicine Physician
  • Bridgeport, MI
National Provider Identifier
1447248232
Registry record updated Apr 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301068741 Issued in MI
Practice address
6297 Dixie Hwy
Bridgeport, MI 48722-9635
Phone
(989) 759-6460
Fax
(989) 759-6465
NPI assigned
Oct 6, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301068741 MI Primary

Addresses

Primary practice location

6297 Dixie Hwy
Bridgeport, MI 48722-9635

Mailing address

501 Lapeer
Health Delivery Inc
Saginaw, MI 48607-1208
Phone (989) 759-6464

Other identifiers 16

IdentifierTypeStateIssuer
080G310660OtherMIBCBS
0985019OtherHEALTHPLUS OF MICHIGAN
1010674OtherMCLAREN HEALTH PLAN
1010674OtherHEALTH ADVANTAGE PPO
11812OtherGREAT LAKES HEALTH PLAN
159OtherMICOMMUNITY CHOICE
5128736OtherAETNA
P101711OtherBLUE CARE NETWORK OF MICH
080179045OtherRAILROAD MEDICARE
1447248232MedicaidMI
381908328OtherUNDER
4336750OtherMOLINA HEALTH CARE OF MIC
381908328OtherHCAP
381908328OtherFIRST HEALTH
381908328OtherPPOM
4336750MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eventure.bernardino@direct.medfusion.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20050304000238 MI Practitioner - Family Practice 7113971946 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301068741MIMDFamily Medicine Physician

Interoperability endpoints

  • Direct secure messaging: eventure.bernardino.1@27771.direct.athenahealth.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617840000000",
    "number": "1447248232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 LAPEER",
            "address_2": "HEALTH DELIVERY INC",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486071208",
            "telephone_number": "989-759-6464",
            "fax_number": "989-399-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6297 DIXIE HWY",
            "city": "BRIDGEPORT",
            "state": "MI",
            "postal_code": "487229635",
            "telephone_number": "989-759-6460",
            "fax_number": "989-759-6465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERNARDINO",
        "first_name": "EVENTURE",
        "middle_name": "DULDULAO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-06",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301068741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "080G310660",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPLUS OF MICHIGAN",
            "identifier": "0985019",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH PLAN",
            "identifier": "1010674",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ADVANTAGE PPO",
            "identifier": "1010674",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES HEALTH PLAN",
            "identifier": "11812",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY CHOICE",
            "identifier": "159",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5128736",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK OF MICH",
            "identifier": "P101711",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080179045",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447248232",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNDER",
            "identifier": "381908328",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA HEALTH CARE OF MIC",
            "identifier": "4336750",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HCAP",
            "identifier": "381908328",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "381908328",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPOM",
            "identifier": "381908328",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4336750",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eventure.bernardino@direct.medfusion.com",
            "affiliation": "N",
            "address_1": "6297 Dixie Hwy",
            "city": "Bridgeport",
            "state": "MI",
            "country_code": "US",
            "postal_code": "487229635",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bridgeport, MI

Sources for this page

Verify at the official NPI Registry.