NPIMap

Individual provider Active NPI

Elizabeth Ann Bohn, PA-C

  • Physician Assistant
  • Saint Louis, MO
National Provider Identifier
1679721179
Registry record updated Jun 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2022029696 Issued in MO
Practice address
3009 N Ballas Rd Ste 383C
Saint Louis, MO 63131-2324
Phone
(314) 996-7014
Fax
(314) 273-0140
NPI assigned
Sep 9, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085003294 IL
Physician Assistant 363A00000X 2022029696 MO Primary

Addresses

Primary practice location

3009 N Ballas Rd Ste 383C
Saint Louis, MO 63131-2324

Mailing address

PO Box 959354
Saint Louis, MO 63195-9354
Phone (314) 996-7014

Other identifiers 5

IdentifierTypeStateIssuer
10019630OtherILBLUE CROSS BLUE SHIELD
115574OtherILHEALTHLINK
033352OtherILHEALTH ALLIANCE
143870OtherILMEDICARE RAILROAD
036067104MedicaidIL

Other names 1

  • Elizabeth Ann Parks Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2 Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20111207000732 IL Practitioner - Physician Assistant 8820268998 Reassigns benefits to 1 organization
I20221031000284 MO Practitioner - Physician Assistant 8820268998 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Southern Illinois University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Groups LCGroup PAC ID 3072421254, 526 clinicians

Practice addresses (Care Compare)

1110 Highlands Plaza Dr E
Saint Louis, MO 63110-1351
Phone (314) 273-0195

2630 Hwy K
O Fallon, MO 63368-6624
Phone (636) 240-5454

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085003294ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Medical Services, NFP CurrentSince Nov 1, 2011 Accepting new patients
Logan Primary Care Physician Assistant Past Accepting new patients
Logan Primary Care Past Accepting new patients
Fairview Heights Medical Group SC Past Accepting new patients
Logan Primary Care Service Corporation Past Accepting new patients
Logan Primary Care Service Corp. Past Accepting new patients

Locations

2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300

405 Rushing Dr
Herrin, IL 62948
Phone (618) 993-3300

Organizations & group practices 7

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780358400000",
    "number": "1679721179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 959354",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631959354",
            "telephone_number": "314-996-7014",
            "fax_number": "314-273-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3009 N BALLAS RD STE 383C",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631312324",
            "telephone_number": "314-996-7014",
            "fax_number": "314-273-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOHN",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-09",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085003294",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2022029696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "10019630",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "115574",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "033352",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "143870",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036067104",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3009 N Ballas Rd Ste 383C",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631312324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "PARKS",
            "middle_name": "ANN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.