SALLY DIANE BONHAM BSN, MSN, FNP, IBCLC
NPI 1811750078
Nurse Practitioner - Family in Waco, TX
About Sally Diane Bonham Bsn, Msn, Fnp, Ibclc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SALLY DIANE BONHAM BSN, MSN, FNP, IBCLC (NPI 1811750078) is an individual family provider in Waco, Texas, licensed in Texas (1182184) and active in the NPI registry since January 2024. She is enrolled in Medicare PECOS, is affiliated with Parkview Regional Hospital, and maintains a secondary practice location in Round Rock.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Secondary Practice Location 1
Accepted Insurance
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
Sally Diane Bonham Bsn, Msn, Fnp, Ibclc 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 Reassignment
Medicare enrollment records show Sally Bonham reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Waco, TX 76708
- Reassigned Medicare billing, Texas enrollment
- 100 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.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Parkview Regional Hospital
Acute Care Hospitals · Mexia, TXPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 76708 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 14
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
WACO, TX 76708
WACO, TX 76708
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 Sally Bonham's NPI number?
The NPI number for Sally Bonham is 1811750078. It was assigned to this individual provider in the NPPES registry on January 31, 2024. The provider is also known as Sally Diane Taylor.
Where is Sally Bonham located?
Sally Bonham practices at 3500 Hillcrest Dr Ste 1, Waco, TX 76708. The listed phone number is (254) 741-6641.
What is Sally Bonham's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Sally Bonham enrolled in Medicare?
Yes. Sally Bonham 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 organization bills Medicare for Sally Bonham's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Sally Bonham reassigns Medicare benefits to Mark Malone MD PA (Waco, TX). 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 Sally Bonham's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Sally Bonham accept?
Health plans from Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 4 other insurers list Sally Bonham 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.
Is Sally Bonham affiliated with any hospitals?
According to CMS data, Sally Bonham is affiliated with Parkview Regional Hospital.
When was this NPI record last updated?
The NPPES record for Sally Bonham was last updated on October 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.
# Sally Diane Bonham, BSN, MSN, FNP, IBCLC · NPI 1811750078
Family physician in Waco, Texas. Individual provider, active in the CMS NPPES registry since January 31, 2024.
## Identity
- **NPI:** 1811750078 (Entity type: Individual)
- **Enumerated:** January 31, 2024
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 1182184 (Texas)
- **Sole proprietor:** No
## Practice location
- **Address:** 3500 HILLCREST DR STE 1, Waco, TX 76708-3144
- **Phone:** (254) 741-6641 · **Fax:** (257) 453-7469
## 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:** Mark Malone MD PA (NPI 1710522859, Waco, TX), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2023
## Record status
- **NPPES last updated:** October 29, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1811750078) · Data from the CMS NPPES public registry.