Individual provider Active NPI

Anthony F Bonacci, M.D.

  • Pediatrics Physician
  • Dorchester, MA
National Provider Identifier
1811922958
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
34425 Issued in MA
Practice address
230 Bowdoin St
Dorchester, MA 02122-1817
Phone
(617) 754-0050
NPI assigned
Jul 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 34425 MA Primary

Addresses

Primary practice location

230 Bowdoin St
Dorchester, MA 02122-1817

Mailing address

230 Bowdoin St
Dorchester, MA 02122-1817
Phone (617) 754-0050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050701000887 MA Practitioner - Pediatric Medicine 4789620436 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34425MAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince May 23, 2008 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince May 23, 2008 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc Past Accepting new patients

Locations

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

230 Bowdoin St
Dorchester, MA 02122
Phone (617) 754-0100

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.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811922958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 BOWDOIN ST",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021221817",
            "telephone_number": "617-754-0050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 BOWDOIN ST",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021221817",
            "telephone_number": "617-754-0050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONACCI",
        "first_name": "ANTHONY",
        "middle_name": "F",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "34425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dorchester, MA

Sources for this page

Verify at the official NPI Registry.