John Mark Buonomo Sr., DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS006593-L Issued in PA

Practice address

446 Domino Lane
Philadephia, PA 19128

Phone

(215) 483-8666

Fax

(215) 483-9616

NPI assigned

Jun 9, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• La Noce Medical Associates

  • Primary Care Clinic/Center
  • Philadelphia, PA
  • NPI 1689612277
  NPD (past)

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272240000000",
    "number": "1619918638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "446 DOMINO LANE",
            "city": "PHILADEPHIA",
            "state": "PA",
            "postal_code": "19128",
            "telephone_number": "215-483-8666",
            "fax_number": "215-483-9616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "446 DOMINO LANE",
            "city": "PHILADEPHIA",
            "state": "PA",
            "postal_code": "19128",
            "telephone_number": "215-483-8666",
            "fax_number": "215-483-9616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUONOMO",
        "first_name": "JOHN",
        "middle_name": "MARK",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2010-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS006593-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megha Akkannappa
• Erin McKenzie Blevins, M.D.
• Franklin Evaristo Caldera, DO
• Dana Lynn Charmoy, LCSW
• Cassandra Kate Diiorio, PA-C
• Katelyn Elizabeth Gerrity
• Golding Home Care

• Family Medicine Physician in Philadephia, PA
• Providers in Philadephia, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2010; 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.

Verify at the official NPI Registry.