JONVANNI BONGOLAN
NPI 1124335807
Nurse Practitioner - Family in La Jolla, CA
About Jonvanni Bongolan NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JONVANNI BONGOLAN (NPI 1124335807) is an individual family provider in La Jolla, California, licensed in California (19774) and active in the NPI registry since September 2010. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jonvanni Bongolan is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Jonvanni Bongolan reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Bethel, AK 99559
- Reassigned Medicare billing, Alaska enrollment
- 9 clinicians in this Medicare group
Kobuk, AK 99751
- Reassigned Medicare billing, Alaska and Texas enrollments
- 100 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 92037 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
LA JOLLA, CA 92037
LA JOLLA, CA 92037
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jonvanni Bongolan's NPI number?
The NPI number for Jonvanni Bongolan is 1124335807. It was assigned to this individual provider in the NPPES registry on September 2, 2010.
Where is Jonvanni Bongolan located?
Jonvanni Bongolan practices at 9300 Campus Point Dr, La Jolla, CA 92037. The listed phone number is (858) 657-6390.
What is Jonvanni Bongolan's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Jonvanni Bongolan enrolled in Medicare?
Yes. Jonvanni Bongolan is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Jonvanni Bongolan's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jonvanni Bongolan reassigns Medicare benefits to 2 organizations: Bethel Family Clinic (Bethel, AK) and Maniilaq Association (Kobuk, AK). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jonvanni Bongolan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Jonvanni Bongolan was last updated on December 7, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jonvanni Bongolan · NPI 1124335807
Family physician in La Jolla, California. Individual provider, active in the CMS NPPES registry since September 2, 2010.
## Identity
- **NPI:** 1124335807 (Entity type: Individual)
- **Enumerated:** September 2, 2010
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 19774 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 9300 CAMPUS POINT DR, La Jolla, CA 92037-1300
- **Phone:** (858) 657-6390
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Bethel Family Clinic (NPI 1124078019, Bethel, AK); Maniilaq Association (NPI 1265709901, Kobuk, AK) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 7, 2010
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Source: [NPI Profile](https://npiprofile.com/npi/1124335807) · Data from the CMS NPPES public registry.