JUDITH JOSE BONIFACIO (RN, MSN, CPNP-PC) – Primary Care Nurse Practitioner, NPI 1629549019
Primary Care Nurse Practitioner
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for JUDITH JOSE BONIFACIO (RN, MSN, CPNP-PC)
PO BOX 733784
DALLAS, TX 753733784
Phone: (682) 885-6483
Fax: (682) 885-3113
Type: Mailing
1500 W ROSEDALE ST
FORT WORTH, TX 761047403
Phone: (682) 885-3426
Fax: (682) 885-7699
Type: Location
1935 Medical District Dr
Dallas, TX 752357701
Phone: (214) 456-2670
Type: Location
3166 S State Highway 161 Ste 170
Grand Prairie, TX 750527720
Phone: (972) 640-0005
Type: Location
6520 N President George Bush Hwy Ste 100
Garland, TX 750443925
Phone: (972) 532-9967
Type: Location
Children's Medical Center of Dallas, 1935, Medical District Drive, Dallas, TX, Dallas, Dallas County, Texas, 75235, United States
DALLAS, TX 752357701
Phone: (214) 456-2670
Type: Location
6520 N PRESIDENT GEORGE BUSH HWY STE 100
GARLAND, TX 750443925
Phone: (972) 532-9967
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: 2019-06-19
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 |
|---|---|---|---|---|
| I20190619002399 | I | Nurse Practitioner | TX | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 75373)
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