Individual provider Active NPI

Jeremy S Bowen, P.A.

  • Physician Assistant
  • Highland, IL
National Provider Identifier
1972615920
Registry record updated Dec 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
12860 Troxler Ave
Highland, IL 62249-2898
Phone
(618) 651-2810
Fax
(618) 651-0077
NPI assigned
Aug 31, 2006
Last updated
Dec 18, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

12860 Troxler Ave
Highland, IL 62249-2898

Mailing address

12860 Troxler Ave
Highland, IL 62249-2898
Phone (618) 651-2810

Other practice location 1

8 Cusumano Professional Plaza Dr
Mount Vernon, IL 62864-6736
Phone (618) 244-4800

Other identifiers 5

IdentifierTypeStateIssuer
P00365761OtherILRR MEDICARE NUMBER
P019009721OtherNYBLUE CHOICE
PA0495OtherNYPREFERRED CARE
207988OtherILMEDICARE GROUP NUMBER
CK7203OtherILRR GROUP NUMBER

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address jbowen74572@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other
Direct Messaging Address jbowen338356@ewd.direct.hshs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070112000209 IL Practitioner - Physician Assistant 7012907124 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
HSHS Medical Group IncGroup PAC ID 5092857821, 212 clinicians
St Josephs Hospital of the Hospital Sisters of the Third Order of St FGroup PAC ID 4183617517, shared by 2 NPIs, 26 clinicians

Practice addresses (Care Compare)

12860 Troxler Ave
Highland, IL 62249-2806
Phone (618) 651-2810

12866 Troxler Ave
Highland, IL 62249-2806
Phone (618) 651-2600

1512 N Green Mount Rd
Ofallon, IL 62269-1953
Phone (618) 624-5510

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
HSHS Prairie, Inc CurrentSince Jan 8, 2024 Accepting new patients
SJL Health Systems Inc CurrentSince Jan 8, 2024 Accepting new patients
St. Mary's Hospital, Centralia, Illinois CurrentSince Feb 14, 2013 Accepting new patients
St. Mary's Hospital, Centralia, Illinois CurrentSince Feb 14, 2013 Accepting new patients
HSHS Medical Group Inc Past Accepting new patients

Locations

400 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5221

432 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5200

7420 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-3155

1900 E Lake Shore Dr
Ste 330
Decatur, IL 62521
Phone (217) 423-2889

12860 Troxler Ave
Highland, IL 62249
Phone (618) 235-3687

8 Cusumano Professional Plaza Dr
Mount Vernon, IL 62864
Phone (618) 242-7819

1512 N Green Mount Rd
O Fallon, IL 62269
Phone (618) 624-0100

Interoperability endpoints

  • Direct secure messaging: jbowen74572@direct-ehr-ssmhc.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702857600000",
    "number": "1972615920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12860 TROXLER AVE",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622492898",
            "telephone_number": "618-651-2810",
            "fax_number": "618-651-0077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12860 TROXLER AVE",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622492898",
            "telephone_number": "618-651-2810",
            "fax_number": "618-651-0077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8 Cusumano Professional Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "IL",
            "postal_code": "628646736",
            "country_code": "US",
            "telephone_number": "618-244-4800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOWEN",
        "first_name": "JEREMY",
        "middle_name": "S",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE NUMBER",
            "identifier": "P00365761",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "P019009721",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "PA0495",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "207988",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR GROUP NUMBER",
            "identifier": "CK7203",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jbowen74572@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jbowen74572@direct-ehr-ssmhc.com",
            "address_1": "432 N Pleasant Ave",
            "city": "Centralia",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628013006",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "432 N Pleasant Ave",
            "city": "Centralia",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628013006",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jbowen338356@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "12860 Troxler Ave",
            "city": "Highland",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622492898",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Highland, IL

Sources for this page

Verify at the official NPI Registry.