Individual provider Active NPI

Megan Bonis

  • Gerontology Nurse Practitioner
  • Niles, IL
National Provider Identifier
1922776186
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
209.023644 Issued in IL
Practice address
7411 N Milwaukee Ave
Niles, IL 60714-3707
Phone
(773) 763-6000
Fax
(773) 763-6006
NPI assigned
Sep 2, 2021
Last updated
Aug 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 209.023644 IL Primary

Addresses

Primary practice location

7411 N Milwaukee Ave
Niles, IL 60714-3707

Mailing address

7411 N Milwaukee Ave
Niles, IL 60714-3707
Phone (773) 763-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211102000385 IL Practitioner - Nurse Practitioner 0840688453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Branch Dermatology LLCGroup PAC ID 8921220914, 5 clinicians

Practice addresses (Care Compare)

7411 N Milwaukee Ave
Niles, IL 60714-3707
Phone (773) 763-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209.023644ILMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Branch Dermatology LLC CurrentSince Oct 1, 2021 Accepting new patients
Kidney and Hypertension Consultants, S.C. PastSince Sep 1, 2021 Accepting new patients

Locations

7447 W Talcott Ave
Ste 425
Chicago, IL 60631
Phone (773) 763-1818

7411 N Milwaukee Ave
Niles, IL 60714
Phone (773) 763-1818

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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": "1630540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1922776186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7411 N MILWAUKEE AVE",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607143707",
            "telephone_number": "773-763-6000",
            "fax_number": "773-763-6006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7411 N MILWAUKEE AVE",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607143707",
            "telephone_number": "773-763-6000",
            "fax_number": "773-763-6006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONIS",
        "first_name": "MEGAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-02",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209.023644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, IL

Sources for this page

Verify at the official NPI Registry.