NPIMap

Individual provider Active NPI

Sean Douglas Bonner, PA

  • Physician Assistant
  • Brooksville, FL
National Provider Identifier
1639120207
Registry record updated Jan 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9101895 Issued in FL
Practice address
17222 Hospital Blvd Ste 242
Brooksville, FL 34601-8925
Phone
(352) 683-0007
NPI assigned
May 16, 2006
Last updated
Jan 29, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9101895 FL Primary

Addresses

Primary practice location

17222 Hospital Blvd Ste 242
Brooksville, FL 34601-8925

Mailing address

17222 Hospital Blvd Ste 242
Brooksville, FL 34601-8925
Phone (352) 683-0007

Other identifiers 1

IdentifierTypeStateIssuer
291189200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9101895FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tampa General Hospital Current Accepting new patients
Southeastern Clinical Services,Inc. PastSince Jun 5, 2012 Accepting new patients
Chen-Sien Hu M D P a Past Accepting new patients
V.P. Nagarajan, M.D. Past Accepting new patients
Rodolfo L Dy MD PA Past Accepting new patients
Suncoast Surgical Assisting Associates, Inc. Physician Assistant Past Accepting new patients
Fawzi Soliman MD PA PastSince Aug 16, 2013 Accepting new patients
Trinity Surgical Associates P a Past Accepting new patients
Nature Coast Surgical Associates, PA Past Accepting new patients
Terrell B. Bounds MD.,PA Past Accepting new patients
John Parrinello, PA PastSince Sep 1, 2006 Accepting new patients
Florida Surgery Consultants, LLC PastSince Jun 1, 2017 Accepting new patients

Interoperability endpoints

  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://fhir4.healow.com/fhir/r4/ECFBCA
  • Direct secure messaging: sbonner281915@direct.tgh.org

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611878400000",
    "number": "1639120207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17222 HOSPITAL BLVD STE 242",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346018925",
            "telephone_number": "352-683-0007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17222 HOSPITAL BLVD STE 242",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346018925",
            "telephone_number": "352-683-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONNER",
        "first_name": "SEAN",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2021-01-29",
        "certification_date": "2021-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291189200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooksville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2021; 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.