Bonnie L Davidson, MD
Individual provider Active NPI Family Medicine Physician · Viroqua, WI
NPI 1568427375 · NPPES record last updated Jun 8, 2018
Key facts
- NPI
- 1568427375
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 49048 (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
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 3
Medicare Care Compare profile
- 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 Inc
Practice addresses (Care Compare)
407 S Main St
Suite 400
Viroqua, WI 54665-4000
Phone (608) 637-3174
Hospital & facility affiliations
- Aveanna Home Health
- Vernon Memorial Hospital
- Vernon Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070726000698 | WI | Practitioner - Family Practice | 0244331866 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49048 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vernon Memorial Healthcare, Inc. | Current |
Accepting new patients | |
| Vernon Memorial Healthcare, Inc | Current |
Accepting new patients | |
| Vernon Memorial Healthcare, Inc. | Past | Accepting new patients | |
| Aspirus Specialist 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
- bdavidson223028@direct.emplifyhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 49048 | WI | Yes |
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
- Bonnie L Suto
Other providers in Viroqua, WI
- Michael Corr
- County of Vernon
- County of Vernon
- Amy Jean Crofts
- David Van Dyke MD SC
- Miranda Dayton
- Dean Saner, Psy.D., LLC
- Sondra Delap
- Paul A Deutsch
- Phoebe Devitt
All providers in Viroqua, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.