Individual provider Active NPI

Jagan Mohan Reddy Bokka I, M.D

  • Family Medicine Physician
  • Mattoon, IL
National Provider Identifier
1124274063
Registry record updated Nov 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-128216 Issued in IL
Practice address
1000 Health Center Dr
Mattoon, IL 61938-9261
Phone
(217) 238-4325
Fax
(217) 348-4290
NPI assigned
Aug 12, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 26478 OK
Hospitalist Physician 208M00000X 036-128216 IL
Family Medicine Physician 207Q00000X 036-128216 IL Primary

Addresses

Primary practice location

1000 Health Center Dr
Mattoon, IL 61938-9261

Mailing address

1005 Health Center Dr Ste 201
Mattoon, IL 61938-4693
Phone (217) 238-6055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20120601000326 IL Practitioner - Family Practice 4688838675 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sarah Bush Lincoln Health CenterGroup PAC ID 5092614867, 411 clinicians

Practice addresses (Care Compare)

1000 Health Ctr Dr
Mattoon, IL 61938-4644

101 Professional PLZ
Mattoon, IL 61938-9252
Phone (217) 238-3730

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.96 of 100Reported as apm
Quality
69.5
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26478OKMDFamily Medicine Physician
036-128216ILMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sarah Bush Lincoln Health Center CurrentSince Aug 10, 2012 Accepting new patients
Sarah Bush Lincoln Health Center Current Accepting new patients

Locations

101 Professional Plz
Mattoon, IL 61938
Phone (217) 238-3730

1000 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-2389

1005 Health Center Dr
Ste 201
Mattoon, IL 61938
Phone (217) 238-6055

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.

Hospital & facility affiliations 1

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": "1218499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542067200000",
    "number": "1124274063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 HEALTH CENTER DR STE 201",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384693",
            "telephone_number": "217-238-6055",
            "fax_number": "217-348-4290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HEALTH CENTER DR",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389261",
            "telephone_number": "217-238-4325",
            "fax_number": "217-348-4290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOKKA",
        "first_name": "JAGAN MOHAN",
        "middle_name": "REDDY",
        "name_suffix": "I",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-12",
        "last_updated": "2018-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "26478",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036-128216",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-128216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mattoon, IL

Sources for this page

Verify at the official NPI Registry.