Suzannah Bong, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

W180N8085 Town Hall Rd
CMH Heart and Vascular Center
Menomonee Falls, WI 53051-3518

Phone

(262) 532-1300

NPI assigned

Mar 29, 2007

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538438400000",
    "number": "1780704510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W180N8085 TOWN HALL RD",
            "address_2": "CMH HEART AND VASCULAR CENTER",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530513518",
            "telephone_number": "262-532-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W180N8085 TOWN HALL RD",
            "address_2": "CMH HEART AND VASCULAR CENTER",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530513518",
            "telephone_number": "262-532-1300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2315 E Moreland Blvd",
            "address_purpose": "LOCATION",
            "city": "Waukesha",
            "state": "WI",
            "postal_code": "531862939",
            "country_code": "US",
            "telephone_number": "262-532-5700",
            "fax_number": "262-532-5701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16650 W Bluemound Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Brookfield",
            "state": "WI",
            "postal_code": "530055959",
            "country_code": "US",
            "telephone_number": "262-827-9200",
            "fax_number": "262-827-9858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONG",
        "first_name": "SUZANNAH",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2018-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780704510",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41939700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Todd Boffeli, M.D.
• Lauren Marie Boldt, OTR
• Michelle Marie Bollig, OTR
• Leslie Ann Bombaci, P.T.
• Kathy J. Bonesho, O.T.
• Jamie Bonoris
• Joseph B Book Book
• Michael Anthony Borkowski, M.D.
• Melissa Born
• Patricia Borrelli, PHARMD, RPH

• Surgical Physician Assistant in Menomonee Falls, WI
• Providers in Menomonee Falls, WI by specialty
• Surgical Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2018; 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.