Jack E Bonham, PA is a medicare enrolled "Physician Assistant" in Beech Grove, Indiana. He graduated from nursing school in 2010 and has 16 years of diverse experience with area of expertise as Physician Assistant. He is a member of the group practice Recover Together Inc and his current practice location is
1600 Albany St, Beech Grove, Indiana. You can reach out to his office (for appointments etc.) via phone at
(317) 802-3151.
Jack E Bonham is licensed to practice in Indiana (license number 10001193A) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1396058608.
Provider's Profile
| Full Name | Jack E Bonham |
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| Gender | Male |
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| Speciality | Physician Assistant |
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| Experience | 16 Years |
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| Location | 1600 Albany St, Beech Grove, Indiana |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Jack E Bonham graduated from nursing school in 2010
NPI Data:
- NPI Number: 1396058608
- Provider Enumeration Date: 07/16/2010
- Last Update Date: 06/25/2021
Medicare PECOS Information:
- PECOS PAC ID: 2769516673
- Enrollment ID: I20100813000845
Medical Identifiers
Medical identifiers for Jack E Bonham such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1396058608 | NPI | - | NPPES |
| 300016938 | Medicaid | IN | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363A00000X | Physician Assistant | 10001193A (Indiana) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Recover Together Inc | 7810247533 | 141 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jack E Bonham allows following entities to bill medicare on his behalf.
| Entity Name | Medical Associates |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1710932736
PECOS PAC ID: 0840184164
Enrollment ID: O20040209000976 |
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| Entity Name | Community Physicians of Indiana Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1619105244
PECOS PAC ID: 1759416662
Enrollment ID: O20100317000717 |
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| Entity Name | Recover Together Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1891102497
PECOS PAC ID: 7810247533
Enrollment ID: O20201029002221 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jack E Bonham is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Jack E Bonham, PA
Po Box 7112, Dpt 31,
Indianapolis, IN 46207-7112
Ph: (317) 802-3151 | Jack E Bonham, PA
1600 Albany St,
Beech Grove, IN 46107-1541
Ph: (317) 802-3151 |
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