Individual provider Active NPI

Matthew J Bonzelet, M.D.

  • Internal Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1861626574
Registry record updated May 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2012021730 Issued in MO
Practice address
1110 Highlands Plaza Dr E
Saint Louis, MO 63110-1350
Phone
(314) 367-3113
NPI assigned
May 8, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 55456-20 WI
Internal Medicine Physician 207R00000X 2012021730 MO Primary

Addresses

Primary practice location

1110 Highlands Plaza Dr E
Saint Louis, MO 63110-1350

Mailing address

1110 Highlands Plaza Dr E
Saint Louis, MO 63110-1350
Phone (314) 367-3113

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20121024000262 MO Practitioner - Internal Medicine 0840440004 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Saint Louis University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

4921 Parkview PL
Suite 5a
Saint Louis, MO 63110-1032
Phone (314) 747-5900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
55456-20WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maryland Medical Group LTD Internal Medicine Current Accepting new patients
Washington University Clinical Associates - Maryland Medical CurrentSince Aug 8, 2012 Accepting new patients
Washington University CurrentSince Jun 1, 2020 Accepting new patients
Washington University CurrentSince Jun 1, 2020 Accepting new patients

Locations

4921 Parkview Pl
Ste 5A
Saint Louis, MO 63110
Phone (314) 362-4211

1110 Highlands Plaza Dr E
Ste 375
Saint Louis, MO 63110
Phone (314) 367-3113

Interoperability endpoints

  • Direct secure messaging: mbonzelet156899@direct.carenet.org

Organizations & group practices 4

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 3

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": "1241740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464480000000",
    "number": "1861626574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 HIGHLANDS PLAZA DR E",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101350",
            "telephone_number": "314-367-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 HIGHLANDS PLAZA DR E",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101350",
            "telephone_number": "314-367-3113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONZELET",
        "first_name": "MATTHEW",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-08",
        "last_updated": "2016-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "55456-20",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2012021730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.