Active NPI
Cris H Bontrager, D.O.
- Surgery Physician
- Jackson, AL
National Provider Identifier
1811909013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- DO-902
- Practice address
- 220 Hospital Dr
Jackson, AL 36545-2459 - Phone
- (251) 246-9021
- Fax
- (251) 246-1122
- NPI assigned
- Aug 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | DO-902 | AL | Primary |
Addresses
Primary practice location
220 Hospital Dr
Jackson, AL 36545-2459
Mailing address
112 Forest Ave
Jackson, AL 36545-2714
Phone (251) 246-5114
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 515-29212 | Other | AL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DO-902 | AL | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| City of Jackson Healthcare Authority | Past | Accepting new patients | |
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Home Health Agency
- Jackson, AL
- NPI 1770593204
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1811909013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 FOREST AVE",
"city": "JACKSON",
"state": "AL",
"postal_code": "365452714",
"telephone_number": "251-246-5114",
"fax_number": "251-246-9553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 HOSPITAL DR",
"city": "JACKSON",
"state": "AL",
"postal_code": "365452459",
"telephone_number": "251-246-9021",
"fax_number": "251-246-1122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONTRAGER",
"first_name": "CRIS",
"middle_name": "H",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "AL",
"license": "DO-902",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "515-29212",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.