Active NPI
Rafael Andres Bonilla Vasquez, M.D.
- Surgery Physician
- Lebanon, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 2019046474
- Practice address
- 120 Hospital Dr Ste 200
Lebanon, MO 65536-9227 - Phone
- (417) 533-6780
- NPI assigned
- Jun 25, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | BP10053644 | TX | |
| Surgery Physician | 208600000X | 2019046474 | MO | Primary |
Addresses
Primary practice location
120 Hospital Dr Ste 200
Lebanon, MO 65536-9227
Mailing address
120 Hospital Dr Ste 200
Lebanon, MO 65536-9227
Phone (417) 533-6780
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- General Surgery
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Clinic Springfield Communities
Practice addresses (Care Compare)
120 Hospital Dr
Suite 200
Lebanon, MO 65536-9227
Phone (417) 553-6780
Hospital & facility affiliations
- Mercy Hospital Lebanon
- Mercy Hospital Springfield
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 34 |
| Hernia repair - groin (open) | 1-10 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 25 |
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019046474 | MO | MD | Surgery Physician |
| BP10053644 | TX | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Clinic Springfield Communities | Current | Accepting new patients | |
| Mercy Clinic Springfield Communities | Current | Accepting new patients | |
| Mercy Clinic Springfield Communities | Current | Accepting new patients |
Locations
120 Hospital Dr
Ste 200
Lebanon, MO 65536
Phone (417) 533-6780
100 W US Highway 60
Mountain View, MO 65548
Phone (417) 934-7000
100 W US Highway 60
Ste 2
Mountain View, MO 65548
Phone (417) 934-2251
1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379
1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379
620 S Glenstone Ave
Springfield, MO 65802
Phone (417) 829-4215
2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905
Interoperability endpoints
- rbonillavasquez1058519@directc.mercy.net
Ownership & related parties
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Mercy Hospital Lebanon | Hospital | Corporate Director | Jul 1, 2021 |
Owned or controlled facilities with NPI records 2
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
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.
-
- Family Medicine Physician
- Springfield, MO
- NPI 1245277631
-
- Rural Health Clinic/Center
- Willow Springs, MO
- NPI 1972771657
-
- Family Medicine Physician
- Hollister, MO
- NPI 1053350454
Hospital & facility affiliations 11
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Lebanon, MO
- NPI 1447284898
-
- General Acute Care Hospital
- Rolla, MO
- NPI 1740413988
-
- General Acute Care Hospital
- Springfield, MO
- NPI 1578504056
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593302400000",
"number": "1871975896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 HOSPITAL DR STE 200",
"city": "LEBANON",
"state": "MO",
"postal_code": "655369227",
"telephone_number": "417-533-6780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 HOSPITAL DR STE 200",
"city": "LEBANON",
"state": "MO",
"postal_code": "655369227",
"telephone_number": "417-533-6780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONILLA VASQUEZ",
"first_name": "RAFAEL",
"middle_name": "ANDRES",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-25",
"last_updated": "2020-06-28",
"certification_date": "2020-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "TX",
"license": "BP10053644",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MO",
"license": "2019046474",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.