MR. NOAH SETH BONNEVILLE PMHNP-BC
NPI 1255460952
Nurse Practitioner - Psychiatric/Mental Health in Santa Clara, CA

Q: What is Noah Bonneville's NPI number?

The NPI number for Noah Bonneville is 1255460952. It was assigned to this individual provider in the NPPES registry on March 6, 2007.

Q: What is Noah Bonneville's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Noah Bonneville was last updated on June 27, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months 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.

Active since March 06, 2007PECOS Enrolled

4633 OLD IRONSIDES DR STE 304, SANTA CLARA, CA 95054(323) 205-7088 Get Directions Write a Review

NPPES record last updated: June 27, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jun 27, 2025, Apr 11, 2025, Oct 26, 2023 and 3 more (6 updates tracked since 2022).

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About Mr. Noah Seth Bonneville Pmhnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. NOAH SETH BONNEVILLE PMHNP-BC (NPI 1255460952) is an individual psychiatric/mental health provider in Santa Clara, California, licensed in California (95021678) and active in the NPI registry since March 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1255460952

Entity TypeIndividualMale

Primary Taxonomy363LP0808X

Provider Legal NameMR. NOAH SETH BONNEVILLECredential: PMHNP-BC

Location Address4633 OLD IRONSIDES DR STE 304Santa Clara, CA 95054-1846

Mailing Address4633 Old Ironsides Dr Ste 304Santa Clara, CA 95054-1846 · (323) 205-7088

Phone(323) 205-7088

Sole ProprietorNo

Enumeration DateMarch 6, 2007

Last NPPES UpdateJune 27, 20256 updates tracked since enumeration

NPPES CertifiedJune 27, 2025

✔ NPI 1255460952 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in CA · 95021678

Also ListedCounselorTaxonomy 101Y00000X

Also ListedNurse PractitionerTaxonomy 363L00000X · License 95021678 (CA)

4633 OLD IRONSIDES DR STE 304, Santa Clara, CA 95054

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Noah Seth Bonneville Pmhnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Noah Bonneville reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Sud Specialty Group - Ca

Same address

Addiction Medicine

4633 OLD IRONSIDES DR STE 304
Santa Clara, CA 95054

Reassigned Medicare billing, California enrollment
1,607 clinicians in this Medicare group

NPI 1972138238 (323) 205-7088

Westside Community Mental Health Center

35 mi

Community/Behavioral Health

245 11TH ST
San Francisco, CA 94103

Reassigned Medicare billing, California enrollment
15 clinicians in this Medicare group

NPI 1437215233 (415) 355-0311

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 95054 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$106.47 typical visit price

range $70.37 – $206.04

Typical copayment $26.61 (range $17.59 – $51.51)

Most-billed visit code 99203

Established Patient

$121.77 typical visit price

range $23.96 – $169.60

Typical copayment $30.44 (range $5.99 – $42.40)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

TRENICE JOHNSON NP

Nurse Practitioner (Psychiatric/Mental Health)