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Bonnie Ann Southworth

Internal Medicine

Allopathic & Osteopathic Physicians

PECOS Enrollment

This provider is enrolled in PECOS as BONNIE SOUTHWORTH.

Based on the most recent information from CMS, provider Bonnie Ann Southworth is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1891752291
Provider Type
Individual
Full Name
Southworth, Bonnie Ann
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
4/28/2006
Last Updated
6/28/2012

Contact Information

Practice Location

75 Francis St, Boston, MA 02115

(612) 732-6315

Unlisted Fax

Mailing Location

111 Cypress St, Brookline, MA 02445

(857) 307-0896

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 79458 Massachusetts

Provider Identifiers

ID	Description	Issuer
ID 3128580	Description Medicaid	Issuer Unlisted Massachusetts

Bonnie Ann Southworth

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Lim, Jonathan Andrew

Redline, Susan

Weiss, Scott T

Speizer, Frank E

Bedell, Susanna

Chin, William W

Kaelin, William G

Firefly Health

Bigby, Judyann

Gagliano Juca D Oliveira, Thiago