Kathleen R Bonaventura, APRN
Individual provider Active NPI Nurse Practitioner · Fairfield, CT
NPI 1821062175 · NPPES record last updated Mar 15, 2010
Key facts
- NPI
- 1821062175
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 002078 (CT)
- Practice address
- 1305 Post Rd
Fairfield, CT 06824-6016 - Phone
- (203) 292-2000
- Fax
- (203) 255-5212
- NPI assigned
- Feb 14, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 86.54
- Promoting interoperability
- 99.98
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080610000579 | CT | Practitioner - Nurse Practitioner | 0749350213 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002078 | CT | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mill Hill Medical Consultants Inc | Current |
Accepting new patients | |
| Northeast Medical Group, Inc. | Nurse Practitioner | Current |
Accepting new patients |
| Cardiac Specialists, P.C. | Past | Accepting new patients |
Locations
1305 Post Rd
Fairfield, CT 06824
Phone (203) 255-3441
831 Boston Post Rd
Ste 103
Milford, CT 06460
Phone (203) 283-5200
95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 002078 | CT | Yes |
Addresses
Primary practice location
1305 Post Rd
Fairfield, CT 06824-6016
Mailing address
103 Thoreau Dr
Shelton, CT 06484-1638
Phone (203) 292-2000
Other providers in Fairfield, CT
- Bojana Jankovic Weatherly MD of New Jersey PC
- John Scott Bomann
- Judy Mary Bonadio
- Mallory Bonarrigo
- Susan R Bonato
- Melissa Bonilla
- Kaitlyn Boorin
- Shayna Borges
- Jolanta Borto
- Frank Michael Boskello Sr.
All providers in Fairfield, CT · Nurse Practitioner in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 15, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.