Bonnie L. Grundel, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9101053 Issued in FL

Practice address

369 N Main St
Crestview, FL 32536-3541

Phone

(850) 398-6963

Fax

(850) 398-8277

NPI assigned

Mar 14, 2006

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

Other identifiers 8

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20458/brand/1/csg/1/fhir/r4

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.

• Crestview Hospital Company LLC

  • Hospitalist Physician
  • Crestview, FL
  • NPI 1861441057
  NPD (past)

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1528036696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 REDSTONE AVE W STE 490",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325366457",
            "telephone_number": "850-689-8321",
            "fax_number": "850-689-8322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 N MAIN ST",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325363541",
            "telephone_number": "850-398-6963",
            "fax_number": "850-398-8277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUNDEL",
        "first_name": "BONNIE",
        "middle_name": "L.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "Y015K",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH FIRST NETWORK",
            "identifier": "17667",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FREEDOM HEALTH",
            "identifier": "P986780",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291926500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMUM",
            "identifier": "P931666",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123872 CRESTVIEW",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCR",
            "identifier": "P00900587",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123873 SANTA ROSA",
            "state": "AL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bonnie.grundel.2@1523.direct.athenhealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "550 Redstone Ave W Ste 490",
            "city": "Crestview",
            "state": "FL",
            "country_code": "US",
            "postal_code": "325366457",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mary Claire Griffith, PT, DPT
• Douglas Nathanael Grimes, CNA
• Justin Grimes, M.S, CFY-SLP
• Rebecca Grimes
• John Anthony Grossi, PHYSICAL THERAPIST
• Esther Grussing, RBT
• Guardian Pharmacy of NW Florida
• Patricia Guess, RN
• Alix Michelle Lemmon Guiette
• Guillot Enterprises, LLC

• Physician Assistant in Crestview, FL
• Providers in Crestview, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.