Active NPI
Leo M. Bonaventura, MD
- Reproductive Endocrinology Physician
- Newburgh, IN
National Provider Identifier
1962419085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Reproductive Endocrinology Physician
- License
- 01022970
- Practice address
- 4199 Gateway Blvd
Suite 2900
Newburgh, IN 47630-8940 - Phone
- (812) 842-4530
- Fax
- (812) 842-4535
- NPI assigned
- Aug 2, 2006
- 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 |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 01022970 | IN | |
| Reproductive Endocrinology Physician | 207VE0102X | 01022970 | IN | Primary |
Addresses
Primary practice location
4199 Gateway Blvd
Suite 2900
Newburgh, IN 47630-8940
Mailing address
4199 Gateway Blvd
Suite 2900
Newburgh, IN 47630-8940
Phone (812) 842-4530
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000328110 | Other | IN | ANTHEM |
| 000000580355 | Other | IN | ANTHEM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01022970 | IN | MD | Reproductive Endocrinology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Major Hospital | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Shelbyville, IN
- NPI 1174555692
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295913600000",
"number": "1962419085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4199 GATEWAY BLVD",
"address_2": "SUITE 2900",
"city": "NEWBURGH",
"state": "IN",
"postal_code": "476308940",
"telephone_number": "812-842-4530",
"fax_number": "812-842-4535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4199 GATEWAY BLVD",
"address_2": "SUITE 2900",
"city": "NEWBURGH",
"state": "IN",
"postal_code": "476308940",
"telephone_number": "812-842-4530",
"fax_number": "812-842-4535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONAVENTURA",
"first_name": "LEO",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-02",
"last_updated": "2011-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "IN",
"license": "01022970",
"primary": false
},
{
"code": "207VE0102X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
"state": "IN",
"license": "01022970",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000328110",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000580355",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newburgh, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.