NPIMap

Individual provider Active NPI

Eliana E Bonfante Mejia, M.D.

  • Diagnostic Radiology Physician
  • Houston, TX
National Provider Identifier
1689612574
Registry record updated Jul 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
M5064 Issued in TX
Practice address
6411 Fannin St
Houston, TX 77030-1501
Phone
(713) 704-2800
NPI assigned
Jun 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X M5064 TX Primary

Addresses

Primary practice location

6411 Fannin St
Houston, TX 77030-1501

Mailing address

PO Box 301173
Dallas, TX 75303-1173
Phone (713) 500-3500

Other identifiers 3

IdentifierTypeStateIssuer
173724902OtherTXCSHCN
8R0316OtherTXBCBS
173724901MedicaidTX

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
I20050616000403 TX Practitioner - Diagnostic Radiology 8022052414 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ut PhysiciansGroup PAC ID 8426960360, 1,744 clinicians

Practice addresses (Care Compare)

8810 Hwy 6
Suite 100
Missouri City, TX 77459-7104
Phone (713) 486-1200

Hospital & facility affiliations

  • Memorial Hermann - Texas Medical Center Hospital, Houston, TX, CCN 450068
  • Harris Health Hospital, Houston, TX, CCN 450289
  • Baptist Beaumont Hospital Hospital, Beaumont, TX, CCN 450346
  • Christus Southeast Texas- St Elizabeth Hospital, Beaumont, TX, CCN 450034

Merit-based Incentive Payment System (MIPS)

Final score
84.11 of 100Reported as group
Quality
69.15
Promoting interoperability
100
Improvement activities
40
Cost
73.63

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M5064TXMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Physicians CurrentSince Mar 1, 2012 Accepting new patients
Ut Physicians Diagnostic Radiology CurrentSince Mar 1, 2012 Accepting new patients
Innovative Radiology PA Diagnostic Radiology PastSince Sep 1, 2002 Accepting new patients
Ut Imaging - Houston LLP Diagnostic Radiology Past Accepting new patients
Houston Medical Imaging Diagnostic Radiology PastSince Jan 30, 2011 Accepting new patients

Locations

6700 West Loop S
Ste 100
Bellaire, TX 77401
Phone (713) 662-9729

6700 West Loop S
Bellaire, TX 77401
Phone (713) 662-9729

6410 Fannin St
Ste 500
Houston, TX 77030
Phone (713) 500-5714

5656 Kelley St
Houston, TX 77026
Phone (713) 566-5000

6431 Fannin St
#2130B
Houston, TX 77030
Phone (713) 500-7631

6411 Fannin St
Houston, TX 77030
Phone (713) 500-6200

8810 Highway 6
Ste 100
Sienna Plantation, TX 77459
Phone (713) 486-1200

Organizations & group practices 6

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 5

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": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469750400000",
    "number": "1689612574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 301173",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753031173",
            "telephone_number": "713-500-3500",
            "fax_number": "713-704-5734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6411 FANNIN ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301501",
            "telephone_number": "713-704-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONFANTE MEJIA",
        "first_name": "ELIANA",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-03",
        "last_updated": "2016-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "M5064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN",
            "identifier": "173724902",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8R0316",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173724901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.