NPIMap

Individual provider Active NPI

Mariah Walker Bonner, DO

  • Family Medicine Physician
  • Florence, MT
National Provider Identifier
1962825356
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
69131 Issued in MT
Practice address
5549 US Highway 93 N
Florence, MT 59833-6845
Phone
(406) 273-4923
NPI assigned
Jan 21, 2014
Last updated
Apr 16, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 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 69131 MT Primary

Addresses

Primary practice location

5549 US Highway 93 N
Florence, MT 59833-6845

Mailing address

PO Box 12
Liberty Lake, WA 99019-0012
Phone (406) 273-4923

Other practice location 1

401 Railroad St W
Missoula, MT 59802-4109
Phone (406) 258-4789

Other practice location 2

104 Rufus Ln
Polson, MT 59860
Phone (406) 883-2555

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mbonner547046@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
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
I20181221001300 MT Practitioner - Family Practice 2769727692 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Western University of Health Sciences College of Dental Med, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Partnership Health Center IncGroup PAC ID 6103843479, 51 clinicians
Providence Health and Services MtGroup PAC ID 6608786306, 358 clinicians

Practice addresses (Care Compare)

401 Railroad St W
Missoula, MT 59802-4178
Phone (406) 258-4789

5549 Old US Hwy 93
Florence, MT 59833-6545
Phone (406) 276-4923

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions19

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
69131MTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Mt Current Accepting new patients
Providence Health & Services Mt Family Medicine CurrentSince Dec 4, 2020 Accepting new patients
Partnership Health Center Inc Family Medicine Current Accepting new patients
Partnership Health Center Inc CurrentSince Oct 31, 2019 Accepting new patients
Providence Health & Services Mt CurrentSince Dec 4, 2020 Accepting new patients
Partnership Health Center Inc CurrentSince Oct 31, 2019 Accepting new patients
Providence Health & Services Mt Past Accepting new patients

Locations

5549 Old US Highway 93
Florence, MT 59833
Phone (406) 273-4923

323 W Alder St
Missoula, MT 59802
Phone (406) 258-4195

401 Railroad St W
Missoula, MT 59802
Phone (406) 258-4183

500 W Broadway St
Missoula, MT 59802
Phone (406) 327-1918

500 W Broadway St
Ste 320
Missoula, MT 59802

104 Rufus Ln
Polson, MT 59860
Phone (406) 543-8512

107 6th Ave SW
Ronan, MT 59864
Phone (406) 676-3600

Interoperability endpoints

  • Direct secure messaging: mbonner547046@wm.providencedirect.org

Organizations & group practices 7

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 8

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": "1390262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1962825356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190012",
            "telephone_number": "406-273-4923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5549 US HIGHWAY 93 N",
            "city": "FLORENCE",
            "state": "MT",
            "postal_code": "598336845",
            "telephone_number": "406-273-4923"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 Railroad St W",
            "address_purpose": "LOCATION",
            "city": "Missoula",
            "state": "MT",
            "postal_code": "598024109",
            "country_code": "US",
            "telephone_number": "406-258-4789",
            "fax_number": "406-258-4732",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "104 Rufus Ln",
            "address_purpose": "LOCATION",
            "city": "Polson",
            "state": "MT",
            "postal_code": "59860",
            "country_code": "US",
            "telephone_number": "406-883-2555",
            "fax_number": "406-883-2559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONNER",
        "first_name": "MARIAH",
        "middle_name": "WALKER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-21",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "69131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbonner547046@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5549 US Highway 93 N",
            "city": "Florence",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598336845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Florence, MT

Sources for this page

Verify at the official NPI Registry.