Dr Keith Anthony Bonacquisti, MD is a medicare enrolled "Otolaryngology" physician in Osage Beach, Missouri. He graduated from medical school in 1985 and has 39 years of diverse experience with area of expertise as Otolaryngology. He is a member of the group practice Lake Regional Medical Management Inc and his current practice location is
1029 Nichols Rd Ste 301, Osage Beach, Missouri. You can reach out to his office (for appointments etc.) via phone at
(573) 302-2864.
Dr Keith Anthony Bonacquisti is licensed to practice in Missouri (license number 109503) and he also participates in the medicare program. He
may accept medicare assignments (which means he may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and his NPI Number is 1487773669.
Physician's Profile
| Full Name | Dr Keith Anthony Bonacquisti |
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| Gender | Male |
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| Speciality | Otolaryngology |
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| Experience | 39 Years |
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| Location | 1029 Nichols Rd Ste 301, Osage Beach, Missouri |
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| Accepts Medicare Assignments | May be. He may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Keith Anthony Bonacquisti graduated from medical school in 1985
NPI Data:
- NPI Number: 1487773669
- Provider Enumeration Date: 03/28/2007
- Last Update Date: 09/24/2019
Medicare PECOS Information:
- PECOS PAC ID: 1153339825
- Enrollment ID: I20120104000462
Medical Identifiers
Medical identifiers for Dr Keith Anthony Bonacquisti such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1487773669 | NPI | - | NPPES |
| 208534602 | Medicaid | MO | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Y00000X | Otolaryngology | 036127592 (Illinois) | Secondary |
| 207Y00000X | Otolaryngology | 109503 (Missouri) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Lake Regional Medical Management Inc | 3577467323 | 46 |
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. Dr Keith Anthony Bonacquisti allows following entities to bill medicare on his behalf.
| Entity Name | Lake Regional Medical Management Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1639134158
PECOS PAC ID: 3577467323
Enrollment ID: O20031122000076 |
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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. Dr Keith Anthony Bonacquisti 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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Dr Keith Anthony Bonacquisti, MD
2 Saint Anthonys Way, Suite 305,
Alton, IL 62002-4569
Ph: (618) 462-2277 | Dr Keith Anthony Bonacquisti, MD
1029 Nichols Rd Ste 301,
Osage Beach, MO 65065-3008
Ph: (573) 302-2864 |
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