Jacob Bonilla, is a medicare enrolled "Physician Assistant - Medical" in Douglas, Arizona. He graduated from nursing school in 2011 and has 15 years of diverse experience with area of expertise as Physician Assistant. He is a member of the group practice Benson Hospital Corporation and his current practice location is
1608 S. Kings Hwy, Douglas, Arizona. You can reach out to his office (for appointments etc.) via phone at
(520) 805-8162.
Jacob Bonilla is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1417300096.
Provider's Profile
| Full Name | Jacob Bonilla |
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| Gender | Male |
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| Speciality | Physician Assistant |
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| Experience | 15 Years |
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| Location | 1608 S. Kings Hwy, Douglas, Arizona |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Jacob Bonilla graduated from nursing school in 2011
NPI Data:
- NPI Number: 1417300096
- Provider Enumeration Date: 07/19/2016
- Last Update Date: 03/21/2022
Medicare PECOS Information:
- PECOS PAC ID: 2365943008
- Enrollment ID: I20250903000288
Medical Identifiers
Medical identifiers for Jacob Bonilla such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1417300096 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363AM0700X | Physician Assistant - Medical | (* (Not Available)) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Benson Hospital Corporation | 3274443056 | 20 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jacob Bonilla allows following entities to bill medicare on his behalf.
| Entity Name | Benson Hospital Corporation |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1336118322
PECOS PAC ID: 3274443056
Enrollment ID: O20040109000537 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jacob Bonilla is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Jacob Bonilla,
2817 Reilly St,
Fort Bragg, NC 28310-8922
Ph: (910) 907-8922 | Jacob Bonilla,
1608 S. Kings Hwy,
Douglas, AZ 85607
Ph: (520) 805-8162 |
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