NPIMap

Individual provider Active NPI

Jennifer N Bohanon

  • Physician Assistant
  • South Boston, VA
National Provider Identifier
1316954597
Registry record updated Dec 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110001842 Issued in VA
Practice address
2232 Wilborn Ave
Suite a
South Boston, VA 24592-1662
Phone
(434) 572-8977
Fax
(434) 572-2510
NPI assigned
Aug 1, 2006
Last updated
Dec 11, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110001842 VA Primary

Addresses

Primary practice location

2232 Wilborn Ave
Suite a
South Boston, VA 24592-1662

Mailing address

PO Box 1115
South Boston, VA 24592-1115
Phone (434) 517-3515

Other practice location 1

2410 Atherholt Rd
Lynchburg, VA 24501-2148
Phone (434) 200-5252

Other identifiers 1

IdentifierTypeStateIssuer
P00167510MedicaidVA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040603000646 VA Practitioner - Physician Assistant 3072595073 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of North Dakota School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

140 Vista Centre Dr
Forest, VA 24551-3965

2232 Wilborn Ave
Suite a
South Boston, VA 24592-1662

2901 S Lynnhaven Rd
Suite 450
Virginia Beach, VA 23452-8524

PO Box
Suite 1115
South Boston, VA 24592

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.16 of 100Reported as apm
Quality
83.58
Promoting interoperability
94
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Interoperability endpoints

  • Direct secure messaging: jbohanon524230@direct.sentara.net

Organizations & group practices 1

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

Hospital & facility affiliations 8

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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702252800000",
    "number": "1316954597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1115",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921115",
            "telephone_number": "434-517-3515",
            "fax_number": "434-572-4549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2232 WILBORN AVE",
            "address_2": "SUITE A",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921662",
            "telephone_number": "434-572-8977",
            "fax_number": "434-572-2510"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2410 Atherholt Rd",
            "address_purpose": "LOCATION",
            "city": "Lynchburg",
            "state": "VA",
            "postal_code": "245012148",
            "country_code": "US",
            "telephone_number": "434-200-5252",
            "fax_number": "434-200-2851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOHANON",
        "first_name": "JENNIFER",
        "middle_name": "N",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110001842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P00167510",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Boston, VA

Sources for this page

Verify at the official NPI Registry.