Jessica Kathleen Bonatakis, PSY.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PS018803 Issued in PA

Practice address

22 Northeast Dr
Hershey, PA 17033-2732

Phone

(717) 531-8338

Fax

(717) 531-6250

NPI assigned

Sep 1, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jessica Kathleen Bonatakis Former name

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Milton S Hershey Medical Center Physicians GroupGroup PAC ID 3870405483, 1,606 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• The Milton S Hershey Medical Center Physicians Group

  • Orthopaedic Surgery Physician
  • Hershey, PA
  • NPI 1710951744
  Medicare reassignment Care Compare group NPD
• The Milton S Hershey Medical Center Physician Group

  • Body Imaging Physician
  • Hershey, PA
  • NPI 1346215928
  NPD
• The Milton S Hershey Medical Center Physicians Group

  • Clinical Psychologist
  • Hershey, PA
  • NPI 1558336560
  NPD
• The Parent-Child Wellness Place

  • Clinical Psychologist
  • Louisville, KY
  • NPI 1316344534
  NPD (past)

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

{
    "created_epoch": "1251763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1679706113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 858",
            "address_2": "MC A410",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170330858",
            "telephone_number": "800-243-1455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 NORTHEAST DR",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170332732",
            "telephone_number": "717-531-8338",
            "fax_number": "717-531-6250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 University Dr",
            "address_purpose": "LOCATION",
            "city": "Hershey",
            "state": "PA",
            "postal_code": "170332360",
            "country_code": "US",
            "telephone_number": "800-243-1455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONATAKIS",
        "first_name": "JESSICA",
        "middle_name": "KATHLEEN",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-01",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "PA",
            "license": "PS018803",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KY",
            "license": "129694",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "BONATAKIS",
            "middle_name": "KATHLEEN",
            "credential": "PSYD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marianne E Boltz, OD
• Melissa Boltz, D.O.
• Lucas Ryan Bolyard, MD
• Travis Bradley Boman
• Shauna Weise Bomer, M.D.
• Anthony Simon Bonavia, M.D.
• Ramnarine Boodoo, M.B.B.S.
• Sherry K Booher, CRNP
• Matthew Book, COTA
• Angela Devincent Booth, NP

• Clinical Child & Adolescent Psychologist in Hershey, PA
• Providers in Hershey, PA by specialty
• Clinical Child & Adolescent Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.