PRIMARY CARE OF BONNE TERRE
NPI 1962883751
General Practice in Bonne Terre, MO
About Primary Care Of Bonne Terre NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PRIMARY CARE OF BONNE TERRE (NPI 1962883751) is a healthcare organization registered as a general practice in Bonne Terre, Missouri and active in the NPI registry since June 2015. The organization lists Andrew J Ninichuck, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Primary Care Of Bonne Terre is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Primary Care Of Bonne Terre, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Primary Care Of Bonne Terre LLC's NPI number?
The NPI number for Primary Care Of Bonne Terre LLC is 1962883751. It was assigned to this organization in the NPPES registry on June 17, 2015. The provider is doing business as Primary Care Of Bonne Terre.
Where is Primary Care Of Bonne Terre LLC located?
Primary Care Of Bonne Terre LLC is located at 527 Benham St, Bonne Terre, MO 63628. The listed phone number is (573) 358-9119.
What is Primary Care Of Bonne Terre LLC's specialty?
The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.
Is Primary Care Of Bonne Terre LLC enrolled in Medicare?
Yes. Primary Care Of Bonne Terre LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Primary Care Of Bonne Terre LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Primary Care Of Bonne Terre LLC, in General Practice and Nurse Practitioner. A 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 the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Primary Care Of Bonne Terre LLC accept?
Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan and Ambetter of Oklahoma and 2 other insurers list Primary Care Of Bonne Terre LLC 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 Primary Care Of Bonne Terre LLC was last updated on November 23, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years 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.
# Primary Care Of Bonne Terre · NPI 1962883751
General Practice organization in Bonne Terre, Missouri. Organization record, active in the CMS NPPES registry since June 17, 2015.
## Identity
- **NPI:** 1962883751 (Entity type: Organization)
- **Enumerated:** June 17, 2015
- **Primary specialty:** General Practice · taxonomy 208D00000X
- **Legal business name:** Primary Care Of Bonne Terre Llc
- **Organization subpart:** No
- **Authorized official:** Andrew Ninichuck, OWNER
## Practice location
- **Address:** 527 BENHAM ST, Bonne Terre, MO 63628-1205
- **Phone:** (573) 358-9119 · **Fax:** (573) 358-9489
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: General Practice (1), Nurse Practitioner (1); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 23, 2015
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Source: [NPI Profile](https://npiprofile.com/npi/1962883751) · Data from the CMS NPPES public registry.