Active NPI
Luigi Vittorio Bonomini, M.D.
- Nephrology Physician
- West Orange, NJ
National Provider Identifier
1992771349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 25MA06470800
- Practice address
- 767 Northfield Ave
West Orange, NJ 07052-1194 - Phone
- (973) 419-0417
- Fax
- (862) 766-5904
- NPI assigned
- Feb 26, 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 25MA064708000 | NJ | |
| Internal Medicine Physician | 207R00000X | 1932-29 | NY | |
| Nephrology Physician | 207RN0300X | 25MA06470800 | NJ | Primary |
| Nephrology Physician | 207RN0300X | 1932-29 | NY |
Addresses
Primary practice location
767 Northfield Ave
West Orange, NJ 07052-1194
Mailing address
767 Northfield Ave
West Orange, NJ 07052-1194
Phone (973) 419-0417
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7551401 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040707000728 | NJ | Practitioner - Nephrology | 4284611237 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Nephrology
- Education
- Other, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Modern Nephrology and Transplant, LLC
Practice addresses (Care Compare)
745 Northfield Ave
Suite 2
West Orange, NJ 07052-1136
Phone (973) 992-9022
767 Northfield Ave
West Orange, NJ 07052-1194
Hospital & facility affiliations
- Innovative Renal Care West Orange
- Cooperman Barnabas Medical Center
- Hackensack Meridian Mountainside Medical
- Clara Maass Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA064708000 | NJ | MD | Internal Medicine Physician |
| 1932-29 | NY | MD | Nephrology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Modern Nephrology & Transplant, LLC | Current | Accepting new patients | |
| Mega Healthcare LLC | Past | Accepting new patients |
Locations
767 Northfield Ave
West Orange, NJ 07052
Phone (973) 736-9004
1500 Pleasant Valley Way
Ste 305
West Orange, NJ 07052
Phone (862) 658-6700
745 Northfield Ave
Ste 2
West Orange, NJ 07052
Phone (973) 325-0061
Interoperability endpoints
- lbonomini188752@ahs.direct-ci.com
- luigi.bonomini@moderntrans.ehi.direct-ci.com
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.
-
- Primary Care Clinic/Center
- Livingston, NJ
- NPI 1548602600
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- West Orange, NJ
- NPI 1235577305
Dialysis facility
-
- General Acute Care Hospital
- Livingston, NJ
- NPI 1396857488
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377043200000",
"number": "1992771349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "767 NORTHFIELD AVE",
"city": "WEST ORANGE",
"state": "NJ",
"postal_code": "070521194",
"telephone_number": "973-419-0417",
"fax_number": "862-766-5904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "767 NORTHFIELD AVE",
"city": "WEST ORANGE",
"state": "NJ",
"postal_code": "070521194",
"telephone_number": "973-419-0417",
"fax_number": "862-766-5904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONOMINI",
"first_name": "LUIGI",
"middle_name": "VITTORIO",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-26",
"last_updated": "2013-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NJ",
"license": "25MA064708000",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "1932-29",
"primary": false
},
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "NJ",
"license": "25MA06470800",
"primary": true
},
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "NY",
"license": "1932-29",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7551401",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Orange, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2013; 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.