MILDREDE N BONGLACK MD
NPI 1134612013
Obstetrics & Gynecology - Urogynecology and Reconstructive Pelvic Surgery in Fresno, CA
About Mildrede N Bonglack Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MILDREDE N BONGLACK MD (NPI 1134612013) is an individual urogynecology and reconstructive pelvic surgery provider in Fresno, California, licensed in California (A204492) and active in the NPI registry since June 2018. She is enrolled in Medicare PECOS, maintains a secondary practice location in Merced, and is a graduate of University Of Cincinnati College Of Medicine (2018).
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Mildrede N Bonglack Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
3Medicare enrollment records show Mildrede Bonglack reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Fresno, CA 93721
- Reassigned Medicare billing, California enrollment
- 295 clinicians in this Medicare group
Le Grand, CA 95333
- Reassigned Medicare billing, California enrollment
- Medicare enrollment name: Golden Valley Health Centers
- 440 clinicians in this Medicare group
Cincinnati, OH 45220
- Reassigned Medicare billing, Ohio enrollment
- 1,102 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 93701 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 13
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
FRESNO, CA 93701
FRESNO, CA 93701
FRESNO, CA 93701
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 Mildrede Bonglack's NPI number?
The NPI number for Mildrede Bonglack is 1134612013. It was assigned to this individual provider in the NPPES registry on June 14, 2018.
Where is Mildrede Bonglack located?
Mildrede Bonglack practices at 2210 E Illinois Ave Ste 408, Fresno, CA 93701. The listed phone number is (559) 443-2694.
What is Mildrede Bonglack's specialty?
The primary specialty registered for this NPI is Obstetrics & Gynecology, specializing in Urogynecology and Reconstructive Pelvic Surgery, with taxonomy code 207VF0040X.
Is Mildrede Bonglack enrolled in Medicare?
Yes. Mildrede Bonglack is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Mildrede Bonglack's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mildrede Bonglack reassigns Medicare benefits to 3 organizations: Central California Faculty Medical Group, Inc. (Fresno, CA), Golden Valley Health Center (Le Grand, CA) and Trihealth H LLC (Cincinnati, OH). 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 Mildrede Bonglack'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 Mildrede Bonglack was last updated on October 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 days 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.
# Mildrede N Bonglack, MD · NPI 1134612013
Urogynecology and Reconstructive Pelvic Surgery physician in Fresno, California. Individual provider, active in the CMS NPPES registry since June 14, 2018.
## Identity
- **NPI:** 1134612013 (Entity type: Individual)
- **Enumerated:** June 14, 2018
- **Primary specialty:** Obstetrics & Gynecology - Urogynecology and Reconstructive Pelvic Surgery · taxonomy 207VF0040X
- **State license:** A204492 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 2210 E ILLINOIS AVE STE 408, Fresno, CA 93701-2184
- **Phone:** (559) 443-2694 · **Fax:** (559) 443-2696
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): Central California Faculty Medical Group, Inc. (NPI 1457603573, Fresno, CA); Golden Valley Health Center (NPI 1356325310, Le Grand, CA); Trihealth H LLC (NPI 1811215742, Cincinnati, OH) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of Cincinnati College Of Medicine, class of 2018
## Record status
- **NPPES last updated:** October 1, 2026
---
Source: [NPI Profile](https://npiprofile.com/npi/1134612013) · Data from the CMS NPPES public registry.