NPIMap

Individual provider Active NPI

Ryan Bonek, M.D.

  • Family Medicine Physician
  • Mishawaka, IN
National Provider Identifier
1730523846
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01077161A Issued in IN
Practice address
4630 Vistula Rd
Mishawaka, IN 46544-4000
Phone
(574) 647-1900
Fax
(574) 647-7206
NPI assigned
Apr 18, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01077161A IN Primary

Addresses

Primary practice location

4630 Vistula Rd
Mishawaka, IN 46544-4000

Mailing address

710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610

Other identifiers 2

IdentifierTypeStateIssuer
201375950MedicaidIN
000001038702OtherINANTHEM

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address BONEK@mybeacon.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20160805000283 IN Practitioner - Family Practice 9335446210 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

4630 Vistula Rd
Mishawaka, IN 46544-4000
Phone (574) 647-1900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group Inc CurrentSince Sep 26, 2016 Accepting new patients
Beacon Medical Group, Inc. Family Medicine CurrentSince Sep 26, 2016 Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

900 I St
Laporte, IN 46350
Phone (219) 324-1670

4630 Vistula Rd
Mishawaka, IN 46544
Phone (219) 254-7200

710 N Niles Ave
South Bend, IN 46617
Phone (574) 647-1610

Interoperability endpoints

  • Direct secure messaging: bonek@mybeacon.cernerdirect.com
  • Direct secure messaging: ryanbonek@beacon.allscriptsdirect.net

Organizations & group practices 3

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 7

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": "1366243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1730523846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610",
            "fax_number": "574-237-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4630 VISTULA RD",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465444000",
            "telephone_number": "574-647-1900",
            "fax_number": "574-647-7206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONEK",
        "first_name": "RYAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-18",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01077161A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201375950",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000001038702",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "BONEK@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "4630 Vistula Rd",
            "city": "Mishawaka",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465444000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.