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JACOB BONILLA
NPI 1417300096
Physician Assistant - Medical in Douglas, AZ

Active since July 19, 2016PECOS EnrolledAccepts Medicare Assignment
1608 S. KINGS HWY, DOUGLAS, AZ 85607(520) 805-8162 Get Directions Write a Review

NPPES record last updated: March 21, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Jacob Bonilla NPPES

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

JACOB BONILLA (NPI 1417300096) is an individual medical provider in Douglas, Arizona and active in the NPI registry since July 2016. He is enrolled in Medicare PECOS, maintains a secondary practice location in Fort Bragg, and is a graduate of Other (2011).

NPPES Registry Identity

NPI1417300096
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameJACOB BONILLA
Location Address1608 S. KINGS HWYDouglas, AZ 85607
Mailing Address2817 Reilly StFort Bragg, NC 28310-8922 · (910) 907-8922 · Fax (910) 907-6069
Phone(520) 805-8162
Sole ProprietorYes
Medical School CMSOtherGraduated 2011
Enumeration DateJuly 19, 2016
Last NPPES UpdateMarch 21, 2022
NPPES CertifiedMarch 8, 2022
✔ NPI 1417300096 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
1608 S. KINGS HWY, Douglas, AZ 85607
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Secondary Practice Location 1

Location 12817 Reilly StFort Bragg, NC 28310-8922 · Phone (910) 907-8922 · Fax (910) 907-6069

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jacob Bonilla 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.

PECOS PAC ID2365943008
PECOS Enrollment IDI20250903000288
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.

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 Jacob Bonilla's NPI number?

The NPI number for Jacob Bonilla is 1417300096. It was assigned to this individual provider in the NPPES registry on July 19, 2016.

Where is Jacob Bonilla located?

Jacob Bonilla practices at 1608 S. Kings Hwy, Douglas, AZ 85607. The listed phone number is (520) 805-8162.

What is Jacob Bonilla's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Jacob Bonilla enrolled in Medicare?

Yes. Jacob Bonilla 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.

What insurance does Jacob Bonilla accept?

Health plans from Ambetter from Arizona Complete Health list Jacob Bonilla as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jacob Bonilla was last updated on March 21, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.