Landyn Paige Bonamico

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1370 Johnson Ave
Bridgeport, WV 26330-1492

Phone

(304) 842-3330

NPI assigned

Aug 18, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

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

State licenses

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.

• Bridgeport Express Care Inc

  • General Practice Physician
  • Bridgeport, WV
  • NPI 1912142001
  Medicare reassignment

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

{
    "created_epoch": "1660780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1801514658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1370 JOHNSON AVE",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263301492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1370 JOHNSON AVE",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263301492",
            "telephone_number": "304-842-3330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONAMICO",
        "first_name": "LANDYN",
        "middle_name": "PAIGE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-18",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Traci R Bodkins
• Breannah Leann Bogus
• Jenna Nicole Bohach, OTR/L
• Ginger Boles, PA
• Kevanna Bolton
• Mia Isabella Bonasso, PA-C
• Holly Elizabeth Bond
• Michael D Bond
• Jessica D Booth
• Chad Michael Boram, LPC

• Physician Assistant in Bridgeport, WV
• Providers in Bridgeport, WV by specialty
• Physician Assistant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; 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.