NPIMap

Individual provider Active NPI

Bonnie L Davidson, MD

  • Family Medicine Physician
  • Viroqua, WI
National Provider Identifier
1568427375
Registry record updated Jun 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
49048 Issued in WI
Practice address
407 S Main St Ste 400
Viroqua, WI 54665
Phone
(608) 637-3174
Fax
(608) 638-5038
NPI assigned
Apr 18, 2006
Last updated
Jun 8, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2018

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 49048 WI Primary

Addresses

Primary practice location

407 S Main St Ste 400
Viroqua, WI 54665

Mailing address

407 S Main St
Ste 400
Viroqua, WI 54665-4000

Other names 1

  • Bonnie L Suto Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20070726000698 WI Practitioner - Family Practice 0244331866 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vernon Memorial Healthcare IncGroup PAC ID 8325958416, shared by 6 NPIs, 73 clinicians

Practice addresses (Care Compare)

407 S Main St
Suite 400
Viroqua, WI 54665-4000
Phone (608) 637-3174

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
49048WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vernon Memorial Healthcare, Inc CurrentSince Nov 30, 2016 Accepting new patients
Vernon Memorial Healthcare, Inc. CurrentSince Nov 30, 2016 Accepting new patients
Aspirus Specialist Inc. Past Accepting new patients
Vernon Memorial Healthcare, Inc. Past Accepting new patients
Aspirus Specialists, Inc. Past Accepting new patients

Locations

206 N Mill St
La Farge, WI 54639
Phone (608) 625-2494

102 Sunset Ave
Soldiers Grove, WI 54655
Phone (608) 624-5203

407 S Main St
Ste 400
Viroqua, WI 54665
Phone (608) 637-3174

507 S Main St
Viroqua, WI 54665
Phone (608) 637-2101

100 Melby St
Westby, WI 54667
Phone (608) 634-3125

Interoperability endpoints

  • Direct secure messaging: bdavidson223028@direct.emplifyhealth.org

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528416000000",
    "number": "1568427375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 S MAIN ST",
            "address_2": "STE 400",
            "city": "VIROQUA",
            "state": "WI",
            "postal_code": "546654000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 S MAIN ST STE 400",
            "city": "VIROQUA",
            "state": "WI",
            "postal_code": "54665",
            "telephone_number": "608-637-3174",
            "fax_number": "608-638-5038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "BONNIE",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-18",
        "last_updated": "2018-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "49048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BONNIE",
            "last_name": "SUTO",
            "middle_name": "L",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Viroqua, WI

Sources for this page

Verify at the official NPI Registry.