Rebecca Rose Bonneville, NURSE PRACTITIONER is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" provider in Los Angeles, California. Her current practice location is
6310 San Vicente Blvd Ste 360, Los Angeles, California. You can reach out to her office (for appointments etc.) via phone at
(323) 870-6161.
Rebecca Rose Bonneville is licensed to practice in California (license number 1821424375) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1821424375.
Healthcare Provider's Profile
| Full Name | Rebecca Rose Bonneville |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Psychiatric/mental Health |
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| Location | 6310 San Vicente Blvd Ste 360, Los Angeles, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1821424375
- Provider Enumeration Date: 09/16/2013
- Last Update Date: 07/21/2022
Medicare PECOS Information:
- PECOS PAC ID: 9335413004
- Enrollment ID: I20190529003203
Medical Identifiers
Medical identifiers for Rebecca Rose Bonneville such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1821424375 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (California) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 22278 (Tennessee) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 1821424375 (California) | Primary |
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. Rebecca Rose Bonneville allows following entities to bill medicare on her behalf.
| Entity Name | Mellow Medical Inc A Professional Corporation |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1407275886
PECOS PAC ID: 3375767403
Enrollment ID: O20140611002222 |
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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. Rebecca Rose Bonneville 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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Rebecca Rose Bonneville, NURSE PRACTITIONER
6310 San Vicente Blvd Ste 360,
Los Angeles, CA 90048-5448
Ph: (323) 870-6161 | Rebecca Rose Bonneville, NURSE PRACTITIONER
6310 San Vicente Blvd Ste 360,
Los Angeles, CA 90048-5448
Ph: (323) 870-6161 |
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