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DIVINE TIM BONGHASEH MD
NPI 1568386324
Family Medicine in Monroe, LA

Active since August 05, 2026PECOS Enrolled
4864 JACKSON ST, MONROE, LA 71202(318) 330-7650 Get Directions Write a Review

NPPES record last updated: August 5, 2026. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Divine Tim Bonghaseh Md NPPES

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

DIVINE TIM BONGHASEH MD (NPI 1568386324) is an individual family medicine provider in Monroe, Louisiana, licensed in Louisiana (353460) and active in the NPI registry since August 2026. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1568386324
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDIVINE TIM BONGHASEHCredential: MD
Location Address4864 JACKSON STMonroe, LA 71202-6400
Mailing Address4864 Jackson StMonroe, LA 71202-6400 · (318) 330-7650
Phone(318) 330-7650
Sole ProprietorNo
Enumeration DateAugust 5, 2026
NPPES CertifiedAugust 5, 2026
✔ NPI 1568386324 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in LA · 353460
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
4864 JACKSON ST, Monroe, LA 71202
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Divine Tim Bonghaseh Md 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 71202 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
$83.60 typical visit price
range $53.43 – $164.73
Typical copayment $20.90 (range $13.35 – $41.18)
Most-billed visit code 99203
Established Patient
$95.09 typical visit price
range $16.64 – $133.62
Typical copayment $23.77 (range $4.16 – $33.40)
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 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. EDDYE BLOSSOM II MD
Obstetrics & Gynecology
4864 JACKSON ST
MONROE, LA 71202
Ouachita Parish (318) 330-7626
HARNOOR SANDHU
Student in an Organized Health Care Education/Training Program
4864 JACKSON ST
MONROE, LA 71202
Ouachita Parish (318) 330-7600
JEFFERY FULLER M.D.
Emergency Medicine
4864 JACKSON ST, DEPARTMENT OF EMERGENCY MEDICAL SERVICES
MONROE, LA 71202
Ouachita Parish (318) 675-7737
DR. WILLIAM TODD YATES MD
Family Medicine
4864 JACKSON ST
MONROE, LA 71202
Ouachita Parish (318) 330-7626
SHANKAR NADESAN MD
Student in an Organized Health Care Education/Training Program
4864 JACKSON ST, DEPT. OF FAMILY MEDICINE
MONROE, LA 71202
Ouachita Parish (318) 330-7615
ANN MARIE CLACK WHNP
Nurse Practitioner (Women's Health)
4864 JACKSON ST
MONROE, LA 71202
Ouachita Parish (318) 330-7000
MR. JONATHAN D BREWER PA
Physician Assistant (Medical)
4864 JACKSON ST
MONROE, LA 71202
Ouachita Parish (318) 330-7626
CALEY WORLEY
Nurse Anesthetist, Certified Registered
4864 JACKSON ST
MONROE, LA 71202
Ouachita Parish (318) 626-0000

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 Divine Tim Bonghaseh's NPI number?

The NPI number for Divine Tim Bonghaseh is 1568386324. It was assigned to this individual provider in the NPPES registry on August 5, 2026.

Where is Divine Tim Bonghaseh located?

Divine Tim Bonghaseh practices at 4864 Jackson St, Monroe, LA 71202. The listed phone number is (318) 330-7650.

What is Divine Tim Bonghaseh's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Divine Tim Bonghaseh enrolled in Medicare?

Yes. Divine Tim Bonghaseh is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Divine Tim Bonghaseh was last updated on August 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.