JACK E BONHAM PA
NPI 1396058608
Physician Assistant in Beech Grove, IN

Q: What is Jack Bonham's NPI number?

The NPI number for Jack Bonham is 1396058608. It was assigned to this individual provider in the NPPES registry on July 16, 2010.

Q: What is Jack Bonham's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Jack Bonham was last updated on June 25, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 16, 2010PECOS EnrolledAccepts Medicare Assignment

1600 ALBANY ST, BEECH GROVE, IN 46107(317) 802-3151(317) 870-0499 Get Directions Write a Review

NPPES record last updated: June 25, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Jack E Bonham Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACK E BONHAM PA (NPI 1396058608) is an individual physician assistant in Beech Grove, Indiana, licensed in Indiana (10001193A) and active in the NPI registry since July 2010. He is enrolled in Medicare PECOS, maintains a secondary practice location in Indianapolis, and is a graduate of Other (2010).

NPPES Registry Identity

NPI1396058608

Entity TypeIndividualMale

Primary Taxonomy363A00000X

Provider Legal NameJACK E BONHAMCredential: PA

Location Address1600 ALBANY STBeech Grove, IN 46107-1541

Mailing AddressPo Box 7112, Dpt 31Indianapolis, IN 46207-7112 · (317) 802-3151 · Fax (317) 870-0499

Phone(317) 802-3151

Fax(317) 870-0499

Sole ProprietorNo

Medical School CMSOtherGraduated 2010

Enumeration DateJuly 16, 2010

Last NPPES UpdateJune 25, 2021

NPPES CertifiedJune 25, 2021

✔ NPI 1396058608 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in IN · 10001193A

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

1600 ALBANY ST, Beech Grove, IN 46107

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Secondary Practice Location 1

Location 11500 N Ritter Ave Ste 500Indianapolis, IN 46219-3027 · Phone (317) 355-5457

Other Identifiers 1

Medicaid300016938IN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jack E Bonham Pa is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2769516673

PECOS Enrollment IDI20100813000845

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Testing for presence of drug, read by direct observation 80305

Testing for the presence of drugs involves collecting a sample, usually urine, which is then analyzed for specific substances. The process is monitored directly to ensure accuracy and integrity. This test helps to confirm if drugs are present in your system.

56 services16 patients

Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (list separately in addition to code for primary procedure) G2088

This service involves office-based treatment for opioid addiction, including coordinating care, individual and group therapy. It extends beyond the initial 2 hours, with every additional half hour listed separately. The focus is on comprehensive care to manage opioid dependency.

54 services14 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

33 services14 patients

Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month G2087

This treatment for opioid use disorder involves regular office visits for coordinated care, individual and group therapy. It aims to manage withdrawal symptoms, prevent relapse, and promote recovery. It's a 60-minute procedure, repeated monthly.

30 services15 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46107 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.04 typical visit price

range $53.07 – $161.76

Typical copayment $20.51 (range $13.26 – $40.44)

Most-billed visit code 99203

Established Patient

$66.48 typical visit price

range $16.93 – $132.22

Typical copayment $16.62 (range $4.23 – $33.05)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MAUREEN FITZPATRICK MD

Emergency Medicine