Individual provider Active NPI

Jennifer S. Wentworth, M.D.

  • Ophthalmology Physician
  • Bowling Green, KY
National Provider Identifier
1033115431
Registry record updated Nov 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
26616 Issued in KY
Practice address
484 Golden Autumn Way Ste 201
Bowling Green, KY 42103-6914
Phone
(270) 780-2494
Fax
(270) 780-0465
NPI assigned
Jun 22, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 26616 KY Primary

Addresses

Primary practice location

484 Golden Autumn Way Ste 201
Bowling Green, KY 42103-6914

Mailing address

201 Park St
Bowling Green, KY 42101-1708
Phone (270) 781-5111

Other identifiers 1

IdentifierTypeStateIssuer
64266166MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100416000540 KY Practitioner - Ophthalmology 8022145481 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
University of Louisville School of Medicine, 1988
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

201 Park St
Bowling Green, KY 42101-1708

729 Moss Creek CT
Bowling Green, KY 42101-5514

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery354

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26616KYMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Graves Gilbert Clinic PLLC CurrentSince Dec 7, 1996 Accepting new patients
Graves Gilbert Clinic PLLC CurrentSince Dec 7, 1996 Accepting new patients

Locations

484 Golden Autumn Way
Ste 201
Bowling Green, KY 42103
Phone (270) 783-3300

825 2nd Ave
Bowling Green, KY 42101
Phone (270) 780-2650

201 Park St
Bowling Green, KY 42101
Phone (270) 651-2229

Interoperability endpoints

  • Direct secure messaging: jenniferwentworth@ggc.allscriptsdirect.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636502400000",
    "number": "1033115431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 PARK ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011708",
            "telephone_number": "270-781-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "484 GOLDEN AUTUMN WAY STE 201",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421036914",
            "telephone_number": "270-780-2494",
            "fax_number": "270-780-0465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENTWORTH",
        "first_name": "JENNIFER",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-22",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "KY",
            "license": "26616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64266166",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

Verify at the official NPI Registry.