Active NPI
James S. Bonner, M.D.
- Neurology Physician
- Ballwin, MO
National Provider Identifier
1720065147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 36152
- Practice address
- 1354 Rusticview Dr
Ballwin, MO 63011-4271 - Phone
- (314) 691-7488
- NPI assigned
- Dec 28, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 36152 | MO | Primary |
Addresses
Primary practice location
1354 Rusticview Dr
Ballwin, MO 63011-4271
Mailing address
1354 Rusticview Dr
Ballwin, MO 63011-4271
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201585841 | Medicaid | MO |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288051200000",
"number": "1720065147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1354 RUSTICVIEW DR",
"city": "BALLWIN",
"state": "MO",
"postal_code": "630114271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1354 RUSTICVIEW DR",
"city": "BALLWIN",
"state": "MO",
"postal_code": "630114271",
"telephone_number": "314-691-7488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONNER",
"first_name": "JAMES",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-28",
"last_updated": "2010-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MO",
"license": "36152",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201585841",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ballwin, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.