ERICHSEN R BONOSTRO (PAC) – Surgical Physician Assistant, NPI 1902170327
Surgical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
9,231 PHYSICIAN ASSISTANT in FL
Provider Addresses for ERICHSEN R BONOSTRO (PAC)
1324 LAKELAND HILLS BLVD
ATTN: MANAGED CARE DEPT.
LAKELAND, FL 33805
Phone:
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 9 Open Payments records for all available years, with a total value of $500.
Total Amount is formed as General ($500) + Research ($0) + Ownership ($0) = $500.
Last reported payment date: 2024-06-25 • Largest payer in this snapshot: Medical Device Business Services, Inc. ($368).
Total Amount
$500
General + Research + Ownership
Payments
9
Total payment records
General Amount
$500
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-06-25
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Medical Device Business Services, Inc. | $368 |
| Ethicon US, LLC | $133 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2012-06-26
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20120626000620 | I | Physician Assistant | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 57288 | Creation of sling around urethra in female to control leakage | 15 | 15 | $0 |
| 57425 | Surgical repair of vaginal defect using an endoscope | 11 | 11 | $0 |
Insurance plans in this area (ZIP 33805)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | FL |
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