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MR. JESSE ANTHONY BONILLA PMHNP-BC
NPI 1689440711
Nurse Practitioner - Psychiatric/Mental Health in Santa Ana, CA

Active since November 29, 2023PECOS Enrolled
2112 E 4TH ST STE 228A, SANTA ANA, CA 92705(714) 420-9890(949) 749-7433 Get Directions Write a Review

NPPES record last updated: December 8, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 8, 2025, Jul 10, 2025, Apr 27, 2024 and 1 more (4 updates tracked since 2023).

About Mr. Jesse Anthony Bonilla Pmhnp-bc NPPES

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

MR. JESSE ANTHONY BONILLA PMHNP-BC (NPI 1689440711) is an individual psychiatric/mental health provider in Santa Ana, California, licensed in California (95028137) and active in the NPI registry since November 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1689440711
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameMR. JESSE ANTHONY BONILLACredential: PMHNP-BC
Location Address2112 E 4TH ST STE 228ASanta Ana, CA 92705-3840
Mailing Address2112 E 4th St Ste 228Santa Ana, CA 92705-3840 · (714) 420-9890 · Fax (949) 749-7433
Phone(714) 420-9890
Fax(949) 749-7433
Sole ProprietorNo
Enumeration DateNovember 29, 2023
Last NPPES UpdateDecember 8, 20254 updates tracked since enumeration
NPPES CertifiedDecember 8, 2025
✔ NPI 1689440711 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in CA · 95028137
2112 E 4TH ST STE 228A, Santa Ana, CA 92705
Open in Google Maps ↗

Other Identifiers 1

MedicaidCB540002CA

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Jesse Anthony Bonilla 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 Reassignment

Medicare enrollment records show Jesse Bonilla reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Neurodivergent Psychiatric Specialists
Same address
Internal Medicine
2112 E 4TH ST, STE 228A
Santa Ana, CA 92705
  • Reassigned Medicare billing, California enrollment
  • Medicare enrollment name: Neurodivergent Psychiatric Specialists Nursing
NPI 1417848219 (949) 409-6460

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 92705 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
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$109.96 typical visit price
range $20.84 – $153.61
Typical copayment $27.49 (range $5.21 – $38.40)
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

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

DEMETRIA POSADAS PMNNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
2112 E 4TH ST STE 228A
SANTA ANA, CA 92705
Orange County (562) 342-0566

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 Jesse Bonilla's NPI number?

The NPI number for Jesse Bonilla is 1689440711. It was assigned to this individual provider in the NPPES registry on November 29, 2023.

Where is Jesse Bonilla located?

Jesse Bonilla practices at 2112 E 4th St Ste 228A, Santa Ana, CA 92705. The listed phone number is (714) 420-9890.

What is Jesse Bonilla's specialty?

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

Is Jesse Bonilla enrolled in Medicare?

Yes. Jesse Bonilla is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jesse Bonilla's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jesse Bonilla reassigns Medicare benefits to Neurodivergent Psychiatric Specialists (Santa Ana, CA). The 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 Jesse Bonilla'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 Jesse Bonilla was last updated on December 8, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.