Individual provider Active NPI

Bonny A Hodges, CRNP

  • Primary Care Nurse Practitioner
  • Newtown Square, PA
National Provider Identifier
1750338810
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
SP008526 Issued in PA
Practice address
3803 W Chester Pike Ste 160
Newtown Square, PA 19073-2336
Phone
(484) 596-0350
NPI assigned
May 27, 2006
Last updated
Jan 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X SP008526 PA
Primary Care Nurse Practitioner 363LP2300X SP008526 PA Primary

Addresses

Primary practice location

3803 W Chester Pike Ste 160
Newtown Square, PA 19073-2336

Mailing address

3900 Woodland Ave
Philadelphia, PA 19104-4551
Phone (215) 823-5800

Other practice location 1

3900 Woodland Ave
Philadelphia, PA 19104-4551
Phone (215) 823-5800

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.visn4.va.gov/locations/philadelphia.asp

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20050505001095 PA Practitioner - Nurse Practitioner 6709826027 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

1991 Sproul Rd
Broomall, PA 19008-3512
Phone (610) 325-1390

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP008526PAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Resources for Human Development, Inc. CurrentSince Jun 17, 2017 Accepting new patients
Family Practice & Counseling Services Network, Inc. CurrentSince Jun 17, 2017 Accepting new patients
Main Line Healthcare Nurse Practitioner CurrentSince Mar 1, 2020 Accepting new patients
Resources for Human Development, Inc. Past Accepting new patients
Primary Homecare, LLC Primary Care Past Accepting new patients

Locations

1991 Sproul Rd
Broomall, PA 19008
Phone (484) 476-3700

1991 Sproul Rd
Ste 200
Broomall, PA 19008
Phone (610) 325-1350

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

3803 West Chester Pike
Ste 160
Newtown Square, PA 19073
Phone (484) 337-1530

2300 W Master St
Philadelphia, PA 19121
Phone (267) 687-1172

4700 Wissahickon Ave
Philadelphia, PA 19144
Phone (215) 843-9720

4700 Wissahickon Ave
Bldg D
Philadelphia, PA 19144
Phone (215) 843-9720

4700 Wissahickon Ave
Ste 118
Philadelphia, PA 19144
Phone 26759736006771

4700 Wissahickon Ave
Ste 119
Philadelphia, PA 19144
Phone 2158439720 ext. 3640

6120 Woodland Ave
Fl The
Philadelphia, PA 19142
Phone (215) 727-4721

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1750338810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 WOODLAND AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044551",
            "telephone_number": "215-823-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3803 W CHESTER PIKE STE 160",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "190732336",
            "telephone_number": "484-596-0350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3900 Woodland Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191044551",
            "country_code": "US",
            "telephone_number": "215-823-5800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HODGES",
        "first_name": "BONNY",
        "middle_name": "A",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-27",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP008526",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "PA",
            "license": "SP008526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.visn4.va.gov/locations/philadelphia.asp",
            "affiliation": "N",
            "address_1": "3900 Woodland Ave",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "191044551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Newtown Square, PA

Sources for this page

Verify at the official NPI Registry.