Active NPI
Carrie Ann Bonomo, M.D.
- Pediatrics Physician
- Ferriday, LA
National Provider Identifier
1992705016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 026732
- Practice address
- 204 Serio Blvd
Ferriday, LA 71334 - Phone
- (318) 757-8010
- Fax
- (318) 757-9501
- NPI assigned
- Jul 29, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 026732 | LA | Primary |
Addresses
Primary practice location
204 Serio Blvd
Ferriday, LA 71334
Mailing address
204 Serio Blvd
Ferriday, LA 71334
Phone (318) 757-8010
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1160059 | Medicaid | LA |
Other names 1
- Ms. Carrie Ann Henderson
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 |
|---|---|---|---|
| 026732 | LA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Concordia Parish Hospital Service District Number One | Past | Accepting new patients | |
| Concordia Parish Hospital Service District Number One | Past | Accepting new patients | |
| Concordia Parish Hospital Service District Number One | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Critical Access Hospital
- Ferriday, LA
- NPI 1144227935
-
- Rural Health Clinic/Center
- Ferriday, LA
- NPI 1679513600
-
- Rural Health Clinic/Center
- Vidalia, LA
- NPI 1780190322
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640044800000",
"number": "1992705016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 SERIO BLVD",
"city": "FERRIDAY",
"state": "LA",
"postal_code": "71334",
"telephone_number": "318-757-8010",
"fax_number": "318-757-9501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 SERIO BLVD",
"city": "FERRIDAY",
"state": "LA",
"postal_code": "71334",
"telephone_number": "318-757-8010",
"fax_number": "318-757-9501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONOMO",
"first_name": "CARRIE",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-29",
"last_updated": "2021-12-21",
"certification_date": "2021-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "LA",
"license": "026732",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1160059",
"state": "LA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CARRIE",
"last_name": "HENDERSON",
"middle_name": "ANN",
"prefix": "MS.",
"credential": "M.D.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Ferriday, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.