Individual provider Active NPI

Harold Jonathan Bowersox, D.O.

  • Family Medicine Physician
  • Mentor, OH
National Provider Identifier
1447362066
Registry record updated Feb 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34-003486 Issued in OH
Practice address
9500 Mentor Ave
Suite 360
Mentor, OH 44060-8713
Phone
(440) 255-5508
Fax
(440) 357-4416
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34-003486 OH Primary

Addresses

Primary practice location

9500 Mentor Ave
Suite 360
Mentor, OH 44060-8713

Mailing address

PO Box 714328
Columbus, OH 43271-4328
Phone (440) 354-1899

Other identifiers 3

IdentifierTypeStateIssuer
000000210429OtherOHANTHEM
080180930OtherOHRAILROAD MEDICARE
0548447MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address harold.bowersox@lhpg.eclinicaldirectplus.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20091229000438 OH Practitioner - Family Practice 9830239656 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34-003486OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Hospital System Inc Family Medicine Current Accepting new patients
Lake Hospital System, Inc Family Medicine CurrentSince Dec 14, 2014 Accepting new patients
Lake Hospital System, Inc. CurrentSince Dec 14, 2014 Accepting new patients

Locations

8655 Market St
Mentor, OH 44060
Phone (440) 255-6400

9500 Mentor Ave
Ste 360
Mentor, OH 44060
Phone (440) 255-5508

10780 Kinsman Rd
Newbury, OH 44065
Phone (440) 564-5656

Interoperability endpoints

  • Direct secure messaging: hbowersox37111@ehrdirect.uhhospitals.org

Organizations & group practices 3

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1447362066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 714328",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432714328",
            "telephone_number": "440-354-1899",
            "fax_number": "440-354-1845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 MENTOR AVE",
            "address_2": "SUITE 360",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440608713",
            "telephone_number": "440-255-5508",
            "fax_number": "440-357-4416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOWERSOX",
        "first_name": "HAROLD",
        "middle_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34-003486",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000210429",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080180930",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0548447",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "harold.bowersox@lhpg.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "Baseline West Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "8655 Market Street",
            "city": "Mentor",
            "state": "OH",
            "country_code": "US",
            "postal_code": "44060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mentor, OH

Sources for this page

Verify at the official NPI Registry.