Individual provider Active NPI

Bowen Jiang, M.D.

  • Neurological Surgery Physician
  • Fullerton, CA
National Provider Identifier
1053682971
Registry record updated Nov 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
A168233 Issued in CA
Practice address
100 E Valencia Mesa Dr
Fullerton, CA 92835-3813
Phone
(714) 734-3120
NPI assigned
Jan 24, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 3, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X D0082850 MD
Neurological Surgery Physician 207T00000X A168233 CA Primary

Addresses

Primary practice location

100 E Valencia Mesa Dr
Fullerton, CA 92835-3813

Mailing address

100 E Valencia Mesa Dr Ste 310
Fullerton, CA 92835-3800
Phone (714) 734-3120

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address bjiang1374411@oc.providencedirect.org
Direct Messaging Address bjiang1374411@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170608002221 MD Practitioner - Neurosurgery 7416198874 Reassigns benefits to 1 organization
I20200806000741 CA Practitioner - Neurosurgery 7416198874 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Stanford University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

100 E Valencia Mesa Dr
Suite 105
Fullerton, CA 92835-3816
Phone (714) 871-3006

1100 W Stewart Dr
Orange, CA 92868-3849
Phone (714) 633-9111

1140 W la Veta Ave
Suite 770
Orange, CA 92868-4229
Phone (714) 835-8715

1950 Sunny Crest Dr
Suite 2900
Fullerton, CA 92835-3641
Phone (714) 992-5350

955 W Imperial Hwy
Suite 110
Brea, CA 92821-3814
Phone (714) 449-6900

Hospital & facility affiliations

  • Providence at Home With Compassus Home Health Orange County Home health agency, Anaheim, CA, CCN 057600
  • Providence St. Jude Medical Center Hospital, Fullerton, CA, CCN 050168
  • Providence St. Joseph Hospital Hospital, Orange, CA, CCN 050069

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion128
Laminectomy or laminotomy (partial removal of spine bones)38

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A168233CAMDNeurological Surgery Physician
D0082850MDMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Lifebridge Orthopedic Specialists, LLC Neurological Surgery CurrentSince Apr 26, 2017 Accepting new patients
Providence Medical Foundation CurrentSince Jul 1, 2020 Accepting new patients
Providence Medical Foundation CurrentSince Jul 1, 2020 Accepting new patients
Providence Medical Foundation Past Accepting new patients
St Jude Hospital Inc Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

100 E Valencia Mesa Dr
Ste 310
Fullerton, CA 92835
Phone (714) 446-5200

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

100 E Valencia Mesa Dr
Fullerton, CA 92835
Phone (714) 447-5027

1140 W La Veta Ave
Ste 560
Orange, CA 92868
Phone (714) 280-1645

2401 W Belvedere Ave
Baltimore, MD 21215

5415 Old Court Rd
Ste S04
Randallstown, MD 21133
Phone (410) 701-4437

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: bjiang1374411@oc.providencedirect.org

Organizations & group practices 7

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1327363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1053682971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E VALENCIA MESA DR STE 310",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353800",
            "telephone_number": "714-734-3120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E VALENCIA MESA DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353813",
            "telephone_number": "714-734-3120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIANG",
        "first_name": "BOWEN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-24",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MD",
            "license": "D0082850",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": "A168233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bjiang1374411@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "100 E Valencia Mesa Dr",
            "city": "Fullerton",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928353813",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bjiang1374411@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1140 W La Veta Ave Ste 560",
            "city": "Orange",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928684214",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.