Bonifasiyo K. Ssennyamantono, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

35788 Issued in AZ

Practice address

10815 W McDowell Rd
Suite 202
Avondale, AZ 85392-5007

Phone

(623) 433-0202

Fax

(623) 433-0206

NPI assigned

Aug 2, 2006

Last updated

Jul 31, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Cardiovascular Disease (Cardiology)

Education

Columbia University College of Physicians and Surgeons, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Privia Medical Group Arizona, LLCGroup PAC ID 1052328408, 94 clinicians

Summit Healthcare AssociationGroup PAC ID 3779568647, 78 clinicians

Sjhmc Physician ServicesGroup PAC ID 4486646197, 645 clinicians

Summit Healthcare Medical AssociatesGroup PAC ID 8729205737, 74 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Summit Healthcare Regional Medical Center Hospital, Show Low, AZ, CCN 030062
• St Josephs Hospital and Medical Center Hospital, Phoenix, AZ, CCN 030024
• Abrazo West Campus Hospital, Goodyear, AZ, CCN 030110

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations (25 of 42)

Interoperability endpoints

• Direct secure messaging: bonifasiyo.ssennyamantono.3@33227.direct.athenahealth.com
• Direct secure messaging: bonifasiyossennyamantono@shrmcshma.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Privia Medical Group Arizona, LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1760441141

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Sjhmc Physician Services

  dba St. Joseph's Faculty Physicians

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1326098005
  Medicare reassignment Care Compare group NPD
• Summit Healthcare Association

  dba Summit Healthcare Regional Medical Center

  • Rural Acute Care Hospital
  • Show Low, AZ
  • NPI 1144209271

  Cardiovascular Disease

  Medicare reassignment Care Compare group NPD
• Summit Healthcare Medical Associates

  • Family Medicine Physician
  • Show Low, AZ
  • NPI 1467878108
  Medicare reassignment Care Compare group
• Hospital Development of West Phoenix Inc

  dba Abrazo West Campus

  • Cardiovascular Disease Physician
  • Goodyear, AZ
  • NPI 1013100692
  Medicare reassignment NPD
• La Paz Regional Hospital Inc

  • Critical Access Hospital
  • Parker, AZ
  • NPI 1053684555
  Medicare reassignment NPD
• St. Joseph's Hospital and Medical Center

  dba SJHMC Trauma Services

  • Emergency Care Clinic/Center
  • Phoenix, AZ
  • NPI 1255382412
  Medicare reassignment NPD
• La Paz Regional Hospital Inc

  • Urgent Care Clinic/Center
  • Parker, AZ
  • NPI 1598009029
  NPD
• Privia Medical Group Arizona, LLC

  • Neurology Physician
  • Phoenix, AZ
  • NPI 1245876705
  NPD
• Privia Medical Group Arizona, LLC

  • Family Medicine Physician
  • Payson, AZ
  • NPI 1740459700
  NPD
• Summit Healthcare Medical Associates

  dba Family Medicine at Bison Ranch

  • Rural Health Clinic/Center
  • Overgaard, AZ
  • NPI 1770700767
  NPD
• City of Hope Medical Group of Arizona LLC

  • Medical Oncology Physician
  • Goodyear, AZ
  • NPI 1609026806

  Internal Medicine

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Dignity Health

  dba St. Josephs Hospital and Medical Center Emergency Dept-Litchfield Park

  • Emergency Care Clinic/Center
  • Litchfield Park, AZ
  • NPI 1265065445

  Hospital

  Care Compare affiliation
• Dignity Health

  dba St. Josephs Hospital and Medical Center Emergency Dept-Glendale

  • Emergency Care Clinic/Center
  • Glendale, AZ
  • NPI 1609408665

  Hospital

  Care Compare affiliation
• Dignity Health

  dba St. Joseph's Hospital and Medical Center

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1982733655
  Care Compare affiliation
• Dignity Health

  dba St. Joseph's Westgate Medical Center

  • General Acute Care Hospital
  • Glendale, AZ
  • NPI 1992131734
  Care Compare affiliation
• Hospital Development of West Phoenix Inc

  dba Abrazo West Campus and Abrazo Maryvale Campus

  • General Acute Care Hospital
  • Goodyear, AZ
  • NPI 1093791170
  Care Compare affiliation
• Summit Healthcare Association

  dba Summit Healthcare Oncology Center

  • Oncology Clinic/Center
  • Show Low, AZ
  • NPI 1083736128

  Hospital

  Care Compare affiliation
• Summit Healthcare Association

  dba Summit Healthcare Regional Medical Center

  • Rural Acute Care Hospital
  • Show Low, AZ
  • NPI 1144209271
  Care Compare affiliation
• Summit Healthcare Medical Associates

  dba Family Medicine at Bison Ranch

  • Rural Health Clinic/Center
  • Overgaard, AZ
  • NPI 1770700767

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1902813678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 E BELL RD STE 4500",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322171",
            "telephone_number": "602-633-3848",
            "fax_number": "602-633-3841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10815 W MCDOWELL RD",
            "address_2": "SUITE 202",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853925007",
            "telephone_number": "623-433-0202",
            "fax_number": "623-433-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SSENNYAMANTONO",
        "first_name": "BONIFASIYO",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AZ",
            "license": "35788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129134",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Spooner Physical Therapy & Hand Rehab, PC (Spooner Avondale)
• Spooner Rehab, PC
• Amanda Kalyca Sprague, PA-C
• Tequilla Marie Sprewer
• Springs of Joy LLC.
• Carol St. Jean Brisebois, SLPA
• Emily W Stafford, DPT
• Jessica Stafford
• Skylar Stagg
• Courtney A Stanczak, RD

• Cardiovascular Disease Physician in Avondale, AZ
• Providers in Avondale, AZ by specialty
• Cardiovascular Disease Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; 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.

Verify at the official NPI Registry.