Jacob Bonilla
NPI 1417300096 · Medical Physician Assistant · Douglas, AZ
Enrolled with Medicare as Practitioner - Physician Assistant · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Jacob Bonilla is a Medical Physician Assistant provider in Douglas, AZ (NPI 1417300096).
Provider details
- NPI number
- 1417300096
- Entity type
- Individual
- Primary specialty
- Medical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 yrs in NPPES registry
- Profile completeness38% of score
83% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Additional practice locations (1)
- 2817 Reilly StFort Bragg, NC 28310-8922Phone: (910) 907-8922Fax: (910) 907-6069
Registry dates
- Enumerated
- 2016-07-19
- Last updated
- 2022-03-21
- Certified
- 2022-03-08
Frequently asked questions
- What is Jacob Bonilla's NPI number?
- Jacob Bonilla's National Provider Identifier (NPI) is 1417300096, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Jacob Bonilla's specialty?
- Jacob Bonilla is listed in the NPPES registry with a primary specialty of Medical Physician Assistant (Physician Assistants & Advanced Practice Nursing Providers).
- Where is Jacob Bonilla located?
- Jacob Bonilla's practice location on file with NPPES is 1608 S. Kings Hwy, Douglas, AZ 85607.
- What is Jacob Bonilla's phone number?
- The practice phone number listed in the NPPES registry for Jacob Bonilla is (520) 805-8162.
- Does Jacob Bonilla accept Medicare?
- Jacob Bonilla is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Is Jacob Bonilla's NPI active?
- Yes — Jacob Bonilla's NPI (1417300096) is active in the NPPES registry as of the last update on 2022-03-21.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.