MR. MARK W BONNEVILLE (MD) – Emergency Medicine Physician, NPI 1336129626
Emergency Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,172 EMERGENCY MEDICINE in MN
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Provider Addresses for MR. MARK W BONNEVILLE (MD)
12955, 30th Avenue North, Plymouth, Hennepin County, Minnesota, 55441, United States
PLYMOUTH, MN 554412738
Phone: (763) 553-1070
Type: Mailing
CentraCare Health – Monticello, 1013, Hart Boulevard, Monticello, Wright County, Minnesota, 55362, United States of America
MONTICELLO, MN 553628575
Phone: (763) 271-2386
Fax: (763) 271-2890
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2005-12-02
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 |
|---|---|---|---|---|
| I20051202000162 | I | Emergency Medicine | MN | 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 |
|---|---|---|---|---|
| 99285 | Emergency department visit with high level of medical decision making | 26 | 26 | $0 |
| 93010 | Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | 17 | 15 | $0 |
| 99284 | Emergency department visit with moderate level of medical decision making | 14 | 14 | $0 |
Insurance plans in this area (ZIP 55441)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MN | |
| Physician Assistant | MN | |
| - | WA | |
| Emergency Medicine | MN | |
| - | MN | |
| Physician Assistant | IA | |
| Emergency Medicine | MN | |
| - | MN | |
| Physician Assistant | MN | |
| Emergency Medicine, Internal Medicine | MN |
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