Active NPI
Susan E. Bonenclark, PA-C
- Physician Assistant
- Belleview, FL
National Provider Identifier
1578541223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9103359
- Practice address
- 5051 SE 110TH St
Belleview, FL 34420-3115 - Phone
- (352) 674-1730
- Fax
- (352) 674-8930
- NPI assigned
- Jan 4, 2006
- Last updated
- Oct 3, 2017
- 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 | PA9103359 | FL | Primary |
Addresses
Primary practice location
5051 SE 110TH St
Belleview, FL 34420-3115
Mailing address
1020 Lake Sumter LNDG
The Villages, FL 32162-2699
Phone (352) 674-8820
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240509002155 | FL | Order and Referring Only - Physician Assistant | 4789608597 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506988800000",
"number": "1578541223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1020 LAKE SUMTER LNDG",
"city": "THE VILLAGES",
"state": "FL",
"postal_code": "321622699",
"telephone_number": "352-674-8820",
"fax_number": "352-674-8919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5051 SE 110TH ST",
"city": "BELLEVIEW",
"state": "FL",
"postal_code": "344203115",
"telephone_number": "352-674-1730",
"fax_number": "352-674-8930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONENCLARK",
"first_name": "SUSAN",
"middle_name": "E.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-04",
"last_updated": "2017-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9103359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belleview, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.