NPIMap

Individual provider Active NPI

Eduardo Jose Gonzalez Bonilla, M.D.

  • Internal Medicine Physician
  • San Angelo, TX
National Provider Identifier
1639573231
Registry record updated Aug 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
S2786 Issued in TX
Practice address
120 E Beauregard Ave
San Angelo, TX 76903-5919
Phone
(325) 658-1511
NPI assigned
Oct 10, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X S2786 TX Primary

Addresses

Primary practice location

120 E Beauregard Ave
San Angelo, TX 76903-5919

Mailing address

PO Box 22000
San Angelo, TX 76902-7200
Phone (325) 658-1511

Other identifiers 2

IdentifierTypeStateIssuer
8LMN32OtherTXBCBS
401122301MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20190824000653 TX Practitioner - Internal Medicine 1557699865 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Shannon ClinicGroup PAC ID 0840103727, 550 clinicians
Dora Roberts Rehabilitation CenterGroup PAC ID 0941285498, 114 clinicians
The West Texas Rehabilitation CenterGroup PAC ID 2860301215, 444 clinicians

Practice addresses (Care Compare)

120 E Beauregard Ave
San Angelo, TX 76903-5919
Phone (325) 747-1511

306 W 3Rd St
Big Spring, TX 79720-2429
Phone (432) 267-3806

4601 Hartford St
Abilene, TX 79605-4603
Phone (325) 793-3411

Hospital & facility affiliations

  • Angels Care Home Health of San Angelo Home health agency, San Angelo, TX, CCN 679429
  • Shannon Home Health Services Home health agency, San Angelo, TX, CCN 457646
  • Paradigm Homecare Home health agency, San Angelo, TX, CCN 747233
  • Enhabit Home Health Home health agency, Abilene, TX, CCN 679184
  • Centerwell Home Health Home health agency, Eastland, TX, CCN 457128
  • Shannon Medical Center Hospital, San Angelo, TX, CCN 450571
  • Heart of Texas Memorial Hospital Hospital, Brady, TX, CCN 451348
  • Shannon Rehabilitation Hospital, an Affiliate of E Inpatient rehabilitation facility, San Angelo, TX, CCN 673078

Merit-based Incentive Payment System (MIPS)

Final score
82.63 of 100Reported as group
Quality
78.21
Promoting interoperability
96
Improvement activities
40
Cost
67.22

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Shannon Clinic Multi-Specialty CurrentSince Aug 1, 2019 Accepting new patients
Shannon Clinic Multi-Specialty CurrentSince Aug 1, 2019 Accepting new patients
Shannon Rehabilitation Hospital, LLC Past Accepting new patients

Locations

120 E Beauregard Ave
San Angelo, TX 76903
Phone (915) 658-1511

Interoperability endpoints

  • Direct secure messaging: egonzalezbonilla31343@shannonhealth.direct-ci.com

Organizations & group practices 11

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.

Hospital & facility affiliations 8

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": "1412899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660867200000",
    "number": "1639573231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22000",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769027200",
            "telephone_number": "325-658-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 E BEAUREGARD AVE",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769035919",
            "telephone_number": "325-658-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ BONILLA",
        "first_name": "EDUARDO",
        "middle_name": "JOSE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-10",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "S2786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8LMN32",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "401122301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Angelo, TX

Sources for this page

Verify at the official NPI Registry.