DR. JODIEY BONDURANT (DNP, CPNP-PC/AC, FNP) – Pediatric Nurse Practitioner, NPI 1104369917
Pediatric Nurse Practitioner
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DR. JODIEY BONDURANT (DNP, CPNP-PC/AC, FNP)
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 972393011
Phone: (503) 494-8122
Fax: (503) 494-1542
Type: Mailing
2100 Madison Ave
Granite City, IL 620404713
Phone: (618) 798-3000
Type: Location
1 Childrens Pl
Saint Louis, MO 631101002
Phone: (314) 454-6336
Type: Location
1835, Ryderwood Court, White House Heights, Hyattsville, Prince George's County, Maryland, 20785, United States
MARYLAND HEIGHTS, MO 630435090
Phone:
Type: Mailing
Gateway Regional Medical Center, 2100, Madison Avenue, Granite City, Madison County, Illinois, 62040, United States
GRANITE CITY, IL 620404713
Phone: (618) 798-3000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2023-05-23
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 |
|---|---|---|---|---|
| I20230523003173 | I | Nurse Practitioner | OR | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 97239)
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