Active NPI
Gail M Bonn, PAC
- Physician Assistant
- Mobridge, SD
National Provider Identifier
1497788939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0390
- Practice address
- 1309 10TH Ave W
Mobridge, SD 57601-1146 - Phone
- (605) 845-3692
- Fax
- (605) 845-8252
- NPI assigned
- Jul 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0390 | SD | Primary |
Addresses
Primary practice location
1309 10TH Ave W
Mobridge, SD 57601-1146
Mailing address
1309 10TH Ave W
Mobridge, SD 57601-1146
Phone (605) 845-3692
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| S103976 | Other | PTAN | |
| 1497788939 | Other | NPI | |
| 6826040 | Medicaid | SD | |
| 1497788939 | Medicaid | SD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0390 | SD | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera St. Luke'S | Past | Accepting new patients | |
| Mobridge Regional Hospital | Past | Accepting new patients | |
| Avera St Lukes | Past | Accepting new patients |
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.
-
- Pathology Technician
- Mobridge, SD
- NPI 1174548937
-
- Family Medicine Physician
- Mobridge, SD
- NPI 1639373756
-
- Rural Health Clinic/Center
- Mobridge, SD
- NPI 1275502577
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447718400000",
"number": "1497788939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1309 10TH AVE W",
"city": "MOBRIDGE",
"state": "SD",
"postal_code": "576011146",
"telephone_number": "605-845-3692",
"fax_number": "605-845-8252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1309 10TH AVE W",
"city": "MOBRIDGE",
"state": "SD",
"postal_code": "576011146",
"telephone_number": "605-845-3692",
"fax_number": "605-845-8252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONN",
"first_name": "GAIL",
"middle_name": "M",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-08",
"last_updated": "2015-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SD",
"license": "0390",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "S103976",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1497788939",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6826040",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1497788939",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mobridge, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.