Active NPI
Dino R Boni Jr., MD
- Gastroenterology Physician
- Avella, PA
National Provider Identifier
1710983192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 12108
- Practice address
- 1953 Brush Run Rd
Avella, PA 15312-2004 - Phone
- (304) 233-9314
- Fax
- (304) 233-0265
- NPI assigned
- Jun 22, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 12108 | WV | Primary |
Addresses
Primary practice location
1953 Brush Run Rd
Avella, PA 15312-2004
Mailing address
1953 Brush Run Rd
Avella, PA 15312-2004
Phone (304) 233-9314
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3002778000 | Medicaid | WV |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dino R Boni Jr MD PC | Gastroenterology | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210550400000",
"number": "1710983192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1953 BRUSH RUN RD",
"city": "AVELLA",
"state": "PA",
"postal_code": "153122004",
"telephone_number": "304-233-9314",
"fax_number": "304-233-0265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1953 BRUSH RUN RD",
"city": "AVELLA",
"state": "PA",
"postal_code": "153122004",
"telephone_number": "304-233-9314",
"fax_number": "304-233-0265"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONI",
"first_name": "DINO",
"middle_name": "R",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-22",
"last_updated": "2008-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "WV",
"license": "12108",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3002778000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Avella, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.