Individual provider Active NPI

Jennifer Bzowy, ANP

  • Women's Health Nurse Practitioner
  • Roseburg, OR
National Provider Identifier
1356447924
Registry record updated Apr 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
201603200NPPP Issued in OR
Practice address
2460 NW Stewart Pkwy
Suite 240
Roseburg, OR 97471-1516
Phone
(541) 677-4427
Fax
(541) 677-6522
NPI assigned
Sep 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 201603200NPPP OR Primary

Addresses

Primary practice location

2460 NW Stewart Pkwy
Suite 240
Roseburg, OR 97471-1516

Mailing address

PO Box 568
Winchester, OR 97495-0568
Phone (541) 677-4427

Other identifiers 1

IdentifierTypeStateIssuer
500713156MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190819002532 OR Practitioner - Nurse Practitioner 5496745614 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
304AKMDPharmacy Technician
201603200NPPPORMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Donald E. Wonderly MD PC CurrentSince Jun 23, 2019 Accepting new patients
Denali OB-GYN Assoc PastSince Jan 1, 2004 Accepting new patients

Locations

2460 NW Stewart Pkwy
Ste 240
Roseburg, OR 97471
Phone (541) 677-4427

Interoperability endpoints

  • Direct secure messaging: jennifer.bzowy.1@26332.direct.athenahealth.com

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": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491177600000",
    "number": "1356447924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 568",
            "city": "WINCHESTER",
            "state": "OR",
            "postal_code": "974950568",
            "telephone_number": "541-677-4427",
            "fax_number": "541-677-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 NW STEWART PKWY",
            "address_2": "SUITE 240",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974711516",
            "telephone_number": "541-677-4427",
            "fax_number": "541-677-6522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BZOWY",
        "first_name": "JENNIFER",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-15",
        "last_updated": "2017-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "OR",
            "license": "201603200NPPP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500713156",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

Verify at the official NPI Registry.