Jennifer Lynn Bauer

Key facts

NPI

1508370859

Entity type

Individual (NPI type 1)

Primary specialty

Primary Care Nurse Practitioner 363LP2300X

License

F11170105 (OH)

Practice address

2400 Clermont Center Dr Ste 200
Batavia, OH 45103-1957

Phone

(513) 735-8400

NPI assigned

Nov 23, 2017

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 10, 2020.

{
    "created_epoch": "1511395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1508370859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 CLERMONT CENTER DR STE 200",
            "city": "BATAVIA",
            "state": "OH",
            "postal_code": "451031957",
            "telephone_number": "513-735-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 CLERMONT CENTER DR STE 200",
            "city": "BATAVIA",
            "state": "OH",
            "postal_code": "451031957",
            "telephone_number": "513-735-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUER",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-23",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OH",
            "license": "F11170105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0254976",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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