Edwin R Bonilla, MD
Individual provider Active NPI Family Medicine Physician · Deridder, LA
NPI 1891806121 · NPPES record last updated Apr 8, 2015
Key facts
- NPI
- 1891806121
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 08674 (LA)
- Practice address
- 403 W 8TH St
Deridder, LA 70634-5507 - Phone
- (337) 463-8977
- Fax
- (337) 462-3093
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University Central del Caribe Escuela de Medicina, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Family Healthcare of Beauregard, LLC
Practice addresses (Care Compare)
403 W 8TH St
Deridder, LA 70634-5507
Phone (337) 463-8977
Hospital & facility affiliations
- Beauregard Memorial Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110413000231 | LA | Practitioner - Family Practice | 7012191208 |
Reassigns benefits to 1 organization Practice locations: Deridder, LA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08674 | LA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chris L Granger M D LLC | Family Medicine | Current | Accepting new patients |
| Jason P Hagen, MD, LLC | Family Medicine | Current | Accepting new patients |
Locations
403 W 8th St
Deridder, LA 70634
Phone (337) 463-8977
Interoperability endpoints
- edwinbonilla@fhcla.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 08674 | LA | Yes |
Addresses
Primary practice location
403 W 8TH St
Deridder, LA 70634-5507
Mailing address
901 Birch Dr
Deridder, LA 70634-5308
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1913324 | Medicaid | LA |
Other providers in Deridder, LA
- Jo Perry Blankenship
- Bliss Day Spa, LLC
- Landon Dale Blood
- Maija Lisa Blood
- Bloom Therapy Center
- Cynthia Boswell
- Dustin Boudreaux
- Brighthope Counseling, LLC
- Alisha Brister
- Brookshire Brothers Inc
All providers in Deridder, LA · Family Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2015. 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.