LOREN E BONENCLARK (PA-C) – Physician Assistant, NPI 1639629579
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
9,231 PHYSICIAN ASSISTANT in FL
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Provider Addresses for LOREN E BONENCLARK (PA-C)
1301, Palm Avenue, Jacksonville, Duval County, Florida, 32207, United States
JACKSONVILLE, FL 322078432
Phone: (904) 202-7300
Fax: (904) 202-7433
Type: Location
PO BOX 45278
JACKSONVILLE, FL 322325278
Phone: (904) 202-2092
Fax: (904) 393-7603
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 45 Open Payments records for all available years, with a total value of $1,462.
Total Amount is formed as General ($1,462) + Research ($0) + Ownership ($0) = $1,462.
Last reported payment date: 2024-10-30 • Largest payer in this snapshot: ABBVIE INC. ($502).
Total Amount
$1,462
General + Research + Ownership
Payments
45
Total payment records
General Amount
$1,462
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-30
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $502 |
| Amgen Inc. | $201 |
| Lilly USA, LLC | $134 |
| Regeneron Healthcare Solutions, Inc. | $115 |
| Organogenesis Inc. | $106 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2019-09-24
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20180801001453 | I | Physician Assistant | MD | TBD |
| I20190924001690 | I | Physician Assistant | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 174 | 41 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 112 | 92 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 78 | 64 | $0 |
| 11102 | Biopsy of related skin growth, first growth | 76 | 71 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 74 | 61 | $0 |
Insurance plans in this area (ZIP 32207)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | FL | |
| Micrographic Dermatologic Surgery (Mds), Dermatology | FL | |
| Physician Assistant | MA | |
| D E R M A T O L O G Y | FL |
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