NPIMap

Individual provider Active NPI

Bonnie Elizabeth Minnick, PA-C

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1811533284
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9112677 Issued in FL
Practice address
700 E Morehead St Ste 300
Charlotte, NC 28202-2742
Phone
(704) 362-5391
NPI assigned
Nov 20, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9112677 FL Primary
Physician Assistant 363A00000X 0010-11796 NC

Addresses

Primary practice location

700 E Morehead St Ste 300
Charlotte, NC 28202-2742

Mailing address

700 E Morehead St Ste 300
Charlotte, NC 28202-2742
Phone (704) 334-7800

Other practice location 1

601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 303-5600

Other names 1

  • Bonnie Widenhouse Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20211216000077 NC Practitioner - Physician Assistant 9830527084 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charlotte Radiology PAGroup PAC ID 4587577390, 222 clinicians

Practice addresses (Care Compare)

Charlotte, NC 28203
Phone (704) 362-5391

Charlotte, NC 28207
Phone (704) 362-5391

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 362-1945

724 Aubrey Bell Dr
Matthews, NC 28105-5055
Phone (704) 295-3550

8800 N Tryon St
Charlotte, NC 28262-3300
Phone (704) 612-4955

920 Church St N
Concord, NC 28025-2927
Phone (704) 334-7800

Hospital & facility affiliations

  • Carolinas Medical Center-Northeast Hospital, Concord, NC, CCN 340001
  • Atrium Health University City Hospital, Charlotte, NC, CCN 340166
  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA9112677FLMDPhysician Assistant
0010-11796NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Charlotte Radiology P a CurrentSince Dec 1, 2021 Accepting new patients

Locations

700 E Morehead St
Ste 300
Charlotte, NC 28202
Phone (704) 442-4390

12335 N Community House Rd
Ste B
Charlotte, NC 28277

724 Aubrey Bell Dr
Matthews, NC 28105
Phone (704) 295-3550

Organizations & group practices 1

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 9

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": "1574208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658102400000",
    "number": "1811533284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 E MOREHEAD ST STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282022742",
            "telephone_number": "704-334-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 E MOREHEAD ST STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282022742",
            "telephone_number": "704-362-5391"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 E Rollins St",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328031248",
            "country_code": "US",
            "telephone_number": "407-303-5600",
            "fax_number": "317-705-5047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MINNICK",
        "first_name": "BONNIE",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-20",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112677",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-11796",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BONNIE",
            "last_name": "WIDENHOUSE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.