Individual provider Active NPI

Mary Kristine Bonn, MD

  • Anesthesiology Physician
  • Phoenix, AZ
National Provider Identifier
1710138474
Registry record updated Sep 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
44277 Issued in AZ
Practice address
1850 N Central Ave
Suite 1600
Phoenix, AZ 85004-4527
Phone
(602) 262-8900
Fax
(602) 262-8890
NPI assigned
Sep 30, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 44277 AZ Primary
Anesthesiology Physician 207L00000X 125-0550717 IL

Addresses

Primary practice location

1850 N Central Ave
Suite 1600
Phoenix, AZ 85004-4527

Mailing address

1850 N Central Ave
Suite 1600
Phoenix, AZ 85004-4527
Phone (602) 262-8900

Other identifiers 1

IdentifierTypeStateIssuer
635367MedicaidAZ

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
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
44277AZMDAnesthesiology Physician
125-0550717ILMDAnesthesiology Physician

NPI Registry JSON

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316649600000",
    "number": "1710138474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 N CENTRAL AVE",
            "address_2": "SUITE 1600",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850044527",
            "telephone_number": "602-262-8900",
            "fax_number": "602-262-8890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 N CENTRAL AVE",
            "address_2": "SUITE 1600",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850044527",
            "telephone_number": "602-262-8900",
            "fax_number": "602-262-8890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONN",
        "first_name": "MARY",
        "middle_name": "KRISTINE",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-30",
        "last_updated": "2011-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AZ",
            "license": "44277",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "125-0550717",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "635367",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; 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.