Bonnie Lynn Brogdon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9109046 Issued in FL

Practice address

3599 University Blvd S
BLDG 300
Jacksonville, FL 32216-4252

Phone

(904) 399-5550

NPI assigned

Jan 19, 2016

Last updated

Jan 19, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ouch, PA

  dba Physicians Pain Center

  • Specialist
  • St Augustine, FL
  • NPI 1144383746
  Medicare reassignment
• Florida Institute of Pain Medicine LLC

  dba Florida Pain Physicians

  • Interventional Pain Medicine Physician
  • Palm Coast, FL
  • NPI 1144913666
  NPD
• Florida Institute of Pain Medicine LLC

  dba Florida Pain Physicians

  • Interventional Pain Medicine Physician
  • Jacksonville, FL
  • NPI 1194056283
  NPD
• Mori Bean and Brooks Inc

  dba Coastal Vein Vascular Institute

  • Diagnostic Radiology Physician
  • Tampa, FL
  • NPI 1093782070

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1453161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453161600000",
    "number": "1720445943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3599 UNIVERSITY BLVD S",
            "address_2": "BLDG 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164252",
            "telephone_number": "904-399-5550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3599 UNIVERSITY BLVD S",
            "address_2": "BLDG 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164252",
            "telephone_number": "904-399-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROGDON",
        "first_name": "BONNIE",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-19",
        "last_updated": "2016-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9109046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Brodskaya, DMD
• Kiya Jane Brody
• Justine A Broecker, M.D.
• Kelly Lynne Broekhof, BSN
• Nyel Brogden
• Tawna Bromhead, DPT
• Timothy Daniel Bromhead, DPT
• Grace Bromley, RDN, LDN
• Thomas P Broner, D.P.M.
• Madison Marie Bronisz

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.