JACK E BONHAM (PA) – Physician Assistant, NPI 1396058608
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,499 PHYSICIAN ASSISTANT in IN
Provider Addresses for JACK E BONHAM (PA)
PO BOX 7112
DPT 31
INDIANAPOLIS, IN 462077112
Phone: (317) 802-3151
Fax: (317) 870-0499
Type: Mailing
1500 N Ritter Ave Ste 500
Indianapolis, IN 462193027
Phone: (317) 355-5457
Type: Location
1600 ALBANY ST
BEECH GROVE, IN 461071541
Phone: (317) 802-3151
Fax: (317) 870-0499
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 12 Open Payments records for all available years, with a total value of $297.
Total Amount is formed as General ($297) + Research ($0) + Ownership ($0) = $297.
Last reported payment date: 2024-10-31 • Largest payer in this snapshot: ABBVIE INC. ($297).
Total Amount
$297
General + Research + Ownership
Payments
12
Total payment records
General Amount
$297
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-31
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $297 |
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: 2010-08-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20100813000845 | I | Physician Assistant | IN | 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 |
|---|---|---|---|---|
| G2087 | 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 | 32 | 12 | $0 |
| 99284 | Emergency department visit with moderate level of medical decision making | 12 | 12 | $0 |
Insurance plans in this area (ZIP 46207)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IN | |
| Nurse Practitioner | IN | |
| Family Practice | ME | |
| Nurse Practitioner | IN | |
| Nurse Practitioner | WV | |
| Anesthesiology, Pain Management | CA | |
| Osteopathic Manipulative Medicine | ME | |
| Emergency Medicine | IN | |
| Nurse Practitioner | IN | |
| Nurse Practitioner | KY |
Reviews
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