Individual provider Active NPI

Julie Bonnin, MD

  • Family Medicine Physician
  • Green Bay, WI
National Provider Identifier
1497770473
Registry record updated Nov 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
42674-20 Issued in WI
Practice address
2253 W Mason St
Green Bay, WI 54303-4706
Phone
(920) 327-7300
Fax
(920) 327-7301
NPI assigned
Jul 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 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 42674-20 WI Primary

Addresses

Primary practice location

2253 W Mason St
Green Bay, WI 54303-4706

Mailing address

2253 W Mason St
Green Bay, WI 54303-4706
Phone (920) 327-7300

Other identifiers 1

IdentifierTypeStateIssuer
34221200MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jbonnin57664@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20060803000447 WI Practitioner - Family Practice 7416960794 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

101 Express Way
Bonduel, WI 54107-9041
Phone (715) 758-6444

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42674-20WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. Family Medicine CurrentSince Sep 12, 2011 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 12, 2011 Accepting new patients
Radiology Associates of Appleton, S.C. Past Accepting new patients

Locations

101 Express Way
Bonduel, WI 54107
Phone (715) 758-6444

2253 W Mason St
Green Bay, WI 54303
Phone (920) 327-7000

2733 S Ridge Rd
Green Bay, WI 54304
Phone (920) 497-6200

123 N Military Ave
Green Bay, WI 54303
Phone (920) 494-3421

3301 W Forest Home Ave
Milwaukee, WI 53215
Phone (414) 389-2233

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

Organizations & group practices 3

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": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637712000000",
    "number": "1497770473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2253 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034706",
            "telephone_number": "920-327-7300",
            "fax_number": "920-327-7301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2253 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034706",
            "telephone_number": "920-327-7300",
            "fax_number": "920-327-7301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONNIN",
        "first_name": "JULIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "42674-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34221200",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jbonnin57664@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2253 W Mason St",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543034706",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2253 W Mason St",
            "city": "Green Bay",
            "state": "WI",
            "country_code": "US",
            "postal_code": "543034706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.