Jerry Craig Bouman, DO
Individual provider Active NPI Surgery Physician · Parsons, KS
NPI 1376518217 · NPPES record last updated Feb 5, 2015
Key facts
- NPI
- 1376518217
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 2996 (OK)
- Practice address
- 1902 S US Highway 59 BLDG D
Parsons, KS 67357-4955 - Phone
- (620) 423-1606
- Fax
- (620) 423-1668
- NPI assigned
- Feb 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 22
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- General Surgery
- Education
- Kansas City University of Med & Biosciences, College of Osteo Med, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Labette County Medical Center
Practice addresses (Care Compare)
1902 S Hwy 59
Parsons, KS 67357-4948
1902 S US Hwy 59
Parsons, KS 67357-4948
Hospital & facility affiliations
- Labette Health
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Upper gastrointestinal (GI) endoscopy for acid reflux | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OK, KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051107000151 | OK | Practitioner - General Surgery | 3476571662 | Reassigns benefits to 1 organization |
| I20090504000026 | KS | Practitioner - General Surgery | 3476571662 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2996 | OK | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Labette County Medical Center | Current |
Accepting new patients | |
| Labette County Medical Center | Current | Accepting new patients | |
| Warren Clinic Inc | Current |
Accepting new patients | |
| Jerry C Bouman DO PC | Surgery | Current | Accepting new patients |
| Labette County Medical Center | Current |
Accepting new patients | |
| Ctca Physicans Group of Oklahoma, Inc | Past | Accepting new patients | |
| Muskogee Medical Group PLLC | Past | Accepting new patients | |
| Surgical Consultants of Muskogee PC | Past | Accepting new patients |
Locations
1527 Madison St
Fredonia, KS 66736
Phone (316) 378-2121
1902 S US Highway 59
Bldg D
Parsons, KS 67357
Phone (620) 421-0830
1902 S US Highway 59
Parsons, KS 67357
Phone (620) 421-4880
715 W Main St
Ste H
Jenks, OK 74037
Phone (918) 313-4792
300 Rockefeller Dr
Muskogee, OK 74401
Phone (918) 682-5501
101 Rockefeller Dr
Ste 203
Muskogee, OK 74401
Phone (918) 681-6847
6600 S Yale Ave
Ste 1400
Tulsa, OK 74136
Phone (888) 247-0125
8803 S 101st East Ave
Ste 350
Tulsa, OK 74133
Phone (918) 252-2800
6600 S Yale Ave
Ste 1200
Tulsa, OK 74136
Phone (918) 488-6045
Interoperability endpoints
- jbouman305130@direct.saintfrancis.com
- jbouman@lh.gwaydirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 2996 | OK | Yes |
Addresses
Primary practice location
1902 S US Highway 59 BLDG D
Parsons, KS 67357-4955
Mailing address
1902 S US Highway 59 BLDG D
Parsons, KS 67357-4955
Phone (620) 423-1606
Other providers in Parsons, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.