Bethany Ilene Bowen, FNP
Individual provider Active NPI Nurse Practitioner · Shiloh, IL
NPI 1609293372 · NPPES record last updated Oct 4, 2023
Key facts
- NPI
- 1609293372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 209011356 (IL)
- Practice address
- 1418 Cross St Ste 250
Shiloh, IL 62269-2965 - Phone
- (618) 236-8000
- NPI assigned
- Mar 19, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Fairview Heights Medical Group SC
Practice addresses (Care Compare)
1418 Cross St
Suite 250
Shiloh, IL 62269-2965
Phone (618) 236-8000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL, MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150213000546 | IL | Practitioner - Nurse Practitioner | 9335464361 | Reassigns benefits to 1 organization |
| I20191115001711 | MO | Practitioner - Nurse Practitioner | 9335464361 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairview Heights Medical Group SC | Current |
Accepting new patients | |
| Fairview Heights Medical Group SC | Current |
Accepting new patients | |
| Associated Physicians Group LTD | Current |
Accepting new patients |
Locations
1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240
916 Talon Dr
#102
O Fallon, IL 62269
Phone (618) 628-8211
1418 Cross St
Ste 250
Shiloh, IL 62269
Phone (618) 236-8000
660 Mason Ridge Center Dr
Saint Louis, MO 63141
Phone (314) 273-6433
845 N New Ballas Ct
Ste 120
Saint Louis, MO 63141
Phone (314) 200-0997
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209011356 | IL | |
| Nurse Practitioner | 363L00000X | 209011356 | IL | Yes |
Addresses
Primary practice location
1418 Cross St Ste 250
Shiloh, IL 62269-2965
Mailing address
1418 Cross St Ste 250
Shiloh, IL 62269-2965
Phone (618) 236-8000
Other practice location 1
4965 Stone Falls Ctr Ste 7
O Fallon, IL 62269-7803
Phone (618) 726-2500
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) |
Other providers in Shiloh, IL
- Michael A Bergom
- Caitlin Jean Besand
- Mia Bilotti-Garmon
- Biovision Clinical LLC
- Evan Blankenship
- Brianna Lee Bowles
- John Albert Boyd
- Breeze Operations, LLC
- Corey Austin Brooks
- Ariana Brown
All providers in Shiloh, IL · Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2023. 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.