NPIMap

Individual provider Active NPI

Bonnie Jo Forman, M.D.

  • Family Medicine Physician
  • Kingwood, WV
National Provider Identifier
1881640282
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19299 Issued in WV
Practice address
150 Memorial Dr
Kingwood, WV 26537-1141
Phone
(304) 329-1400
Fax
(304) 329-6961
NPI assigned
May 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 19299 WV Primary

Addresses

Primary practice location

150 Memorial Dr
Kingwood, WV 26537-1141

Mailing address

2287 S Mountaineer Hwy
Thornton, WV 26440-7171
Phone (304) 265-6963

Other identifiers 1

IdentifierTypeStateIssuer
0048169000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20041102000236 WV Practitioner - Family Practice 4183686165 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Preston Memorial Hospital CorporationGroup PAC ID 5294645107, 46 clinicians

Practice addresses (Care Compare)

150 Memorial Dr
Kingwood, WV 26537-1141
Phone (304) 329-1400

Hospital & facility affiliations

  • Preston Memorial Homecare Home health agency, Kingwood, WV, CCN 517037
  • Stonerise Home Health Home health agency, Morgantown, WV, CCN 517810
  • Amedisys Hospice Care Hospice, Morgantown, WV, CCN 511523
  • Preston Memorial Hospital Hospital, Kingwood, WV, CCN 511312
  • West Virginia University Hospitals, Inc Hospital, Morgantown, WV, CCN 510001
  • Mon Health Medical Center Hospital, Morgantown, WV, CCN 510024

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Preston Memorial Hospital Corporation Family Medicine CurrentSince Apr 1, 2013 Accepting new patients
Preston Memorial Hospital Corporation CurrentSince Apr 1, 2013 Accepting new patients
Preston Memorial Medical Group Past Accepting new patients

Locations

300 S Price St
Kingwood, WV 26537
Phone 3043291400287

410 E Main St
Kingwood, WV 26537
Phone (304) 329-0780

150 Memorial Dr
Kingwood, WV 26537
Phone (304) 329-4701

2287 S Mountaineer Hwy
Thornton, WV 26440
Phone (304) 265-6963

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/preston-adacdb24

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.

FacilityTypeRoleSince
Preston Memorial Hospital CorporationKingwood, WV, CCN 511312 Hospital W-2 Managing Employee Jan 1, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 7

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": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1881640282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2287 S MOUNTAINEER HWY",
            "city": "THORNTON",
            "state": "WV",
            "postal_code": "264407171",
            "telephone_number": "304-265-6963",
            "fax_number": "304-265-6961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MEMORIAL DR",
            "city": "KINGWOOD",
            "state": "WV",
            "postal_code": "265371141",
            "telephone_number": "304-329-1400",
            "fax_number": "304-329-6961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "BONNIE",
        "middle_name": "JO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-26",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "19299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0048169000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingwood, WV

Sources for this page

Verify at the official NPI Registry.