Provider Demographics
NPI:1861631145
Name:O'CONNOR, JILL (PA-C)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:BUSCHUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2587 COMMONS BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3841
Mailing Address - Country:US
Mailing Address - Phone:937-424-5825
Mailing Address - Fax:937-458-0239
Practice Address - Street 1:2587 COMMONS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3841
Practice Address - Country:US
Practice Address - Phone:937-424-5825
Practice Address - Fax:937-424-5829
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002879363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000494547OtherANTHEM
OH$$$$$$$$$-002OtherMMOH
OH000000494547OtherANTHEM
OH000000494547OtherANTHEM