DR. BONIFASIYO K. SSENNYAMANTONO (NPI# 1902813678) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902813678 |
| Entity Type | Individual |
| Full Name | DR. BONIFASIYO K. SSENNYAMANTONO |
| Credential | MD |
| Practice Address |
10815 W Mcdowell Rd Suite 202 Avondale AZ 85392-5007 |
| Practice Telephone | 6234330202 |
| Practice Fax Number | 6234330206 |
| Mailing Telephone | 6234330202 |
| Mailing Fax Number | 6234330206 |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2019-04-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
35788 | AZ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 129134 | 05 |
| Street Address |
10815 W MCDOWELL RD SUITE 202 |
| City | AVONDALE |
| State | AZ |
| Zip Code | 85392-5007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144212721 | Riyaz A Sumar | Specialist | 10815 W Mcdowell Rd, Suite 202, Avondale, AZ 85392-5007 | 2005-08-18 |
| 1538400692 | Alaina Anne Vacco | Physician Assistant | 10815 W Mcdowell Rd, Suite 305, Avondale, AZ 85392-5007 | 2013-03-13 |
| 1952652141 | Thomas Michael Martin | Physician Assistant | 10815 W Mcdowell Rd, Suite 305, Avondale, AZ 85392-5007 | 2012-09-27 |
| 1942597307 | Adam K Griffin | Physical Therapist | 10815 W Mcdowell Rd, Suite 203, Avondale, AZ 85392-5007 | 2011-07-06 |
| 1720211022 | Smi Imaging, LLC | Radiology | 10815 W Mcdowell Rd, Suite 102, Avondale, AZ 85392-5007 | 2009-09-02 |
| 1598996894 | Surgical Elite of Avondale, LLC | Clinic/Center | 10815 W Mcdowell Rd, Suite 101, Avondale, AZ 85392 | 2009-08-04 |
| 1093955908 | Arun S. Patil | Internal Medicine | 10815 W Mcdowell Rd, Suite 202, Avondale, AZ 85392 | 2009-03-05 |
| 1861649998 | Arizona Academy of Health and Performance LLC | Physical Therapist | 10815 W Mcdowell Rd, Ste 304, Avondale, AZ 85392-5007 | 2008-08-20 |
| 1497917660 | Paincare Health Institute LLC | Pain Medicine | 10815 W Mcdowell Rd, Ste 304, Avondale, AZ 85392-5007 | 2008-06-30 |
| 1215195284 | Paincare Health Institute LLC | Clinic/Center | 10815 W Mcdowell Rd, Ste 304, Avondale, AZ 85392-5007 | 2008-05-27 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972100063 | Arizona Imaging Center, LLC | Radiology | 10825 W Mcdowell Rd Suite 130, Avondale, AZ 85392 | 2020-10-02 |
| 1376159053 | Quick Med Center LLC | Clinic/Center | 10825 W Mcdowell Rd Suite 100, Avondale, AZ 85392 | 2020-09-18 |
| 1225641046 | Ambulatory Surgery Centers, LLC | Clinic/Center | 10825 W Mcdowell Rd Suite 110, Avondale, AZ 85392 | 2020-08-31 |
| 1144842394 | National Cardiovascular Surgery Center, LLC | Clinic/Center | 10825 W Mcdowell Rd, Suite 310, Avondale, AZ 85392 | 2020-05-11 |
| 1073077145 | Lakeview Dentistry P.C., Inc. | Dentist | 10750 W. Mcdowell Road, Bldg. D410, Avondale, AZ 85392 | 2019-01-23 |
| 1699249458 | Elaine Van De Wille | Student in an Organized Health Care Education/Training Program | 3609 N 109th Ave, Avondale, AZ 85392 | 2019-01-15 |
| 1750890075 | West Valley Pediatrics | Nurse Practitioner | 10750 West Mcdowell Rd, Suite G700, Avondale, AZ 85392 | 2017-09-29 |
| 1336675305 | Hope-ann Kamler | Licensed Practical Nurse | 2150 North Santa Fe Blvd, Avondale, AZ 85392 | 2017-05-11 |
| 1790237527 | Visionworks, Inc | Eyewear Supplier (Equipment, not the service) | 10285 West Mcdowell Rd, Ste A-102, Avondale, AZ 85392 | 2016-10-27 |
| 1063969137 | Lorri Ward | Registered Nurse | 12750 W Coronado Rd, Avondale, AZ 85392 | 2016-09-07 |
| Find all providers in zip 85392 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376544577 | Karl E.t. Moon | Internal Medicine | 10815 W. Mcdowell Rd., Ste 202, Avondale, AZ 85392-5007 | 2005-08-10 |
| 1790195741 | Upamanyu Rampal | Internal Medicine | 10815 W Mcdowell Rd Ste 202, Avondale, AZ 85392 | 2014-04-29 |
| 1659463362 | Pedro Pablo Ortiz | Internal Medicine | 10815 W Mcdowell Rd Ste 202, Avondale, AZ 85392 | 2006-09-29 |
| 1164539755 | Adhar Seth | Internal Medicine | 10815 W Mcdowell Rd, Suite 202, Avondale, AZ 85392-5007 | 2006-08-23 |
| 1609857705 | Lorne William Murray | Internal Medicine | 10815 W Mcdowell Rd, Ste 202, Avondale, AZ 85392-5007 | 2005-11-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528673092 | Cai Ncp East Mesa Jv LLC | Internal Medicine | 10238 E Hampton Ave Ste 201, Mesa, AZ 85209-3318 | 2020-09-11 |
| 1073131561 | Ponderosa Heart House Call | Internal Medicine | 115 S Alto St Ste 3, Prescott, AZ 86303-3603 | 2020-07-10 |
| 1710504667 | Honorhealth Ambulatory | Internal Medicine | 20201 N Scottsdale Healthcare Dr Ste 200, Scottsdale, AZ 85255-4137 | 2020-06-26 |
| 1174149132 | Honorhealth Ambulatory | Internal Medicine | 9250 W Thomas Rd Ste 300, Phoenix, AZ 85037-3384 | 2020-06-24 |
| 1427523471 | Dr. David Wilcoxson and Associates, LLC | Internal Medicine | 6641 E Baywood Ave Ste B3, Mesa, AZ 85206-1723 | 2018-10-05 |
| 1407343841 | Imran Ata Md Pllc | Internal Medicine | 3925 E Fort Lowell Rd Ste 105, Tucson, AZ 85712 | 2018-04-20 |
| 1245733716 | Argento Medical Group LLC | Internal Medicine | 8410 W Thomas Rd Ste 120, Phoenix, AZ 85037-3356 | 2018-03-12 |
| 1508235730 | Joseph Parraz | Internal Medicine | 14340 S Durango Rd # 4, Arizona City, AZ 85123-8719 | 2015-09-17 |
| 1265809628 | Scottsdale Heart & Vascular Associates LLC | Internal Medicine | 4040 E Larkspur Dr, Phoenix, AZ 85032-7420 | 2015-09-01 |
| 1326438276 | Healthfinity, Pllc | Internal Medicine | 6316 W Union Hills Dr Ste 210, Glendale, AZ 85308-1001 | 2015-01-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.