NPIMap

Individual provider Active NPI

Jonathan Cleon Hendricks, PA-C

  • Physician Assistant
  • Cape Coral, FL
National Provider Identifier
1033185699
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9101920 Issued in FL
Practice address
636 Del Prado Boulevard
Cape Coral, FL 33990-2695
Phone
(239) 424-2222
NPI assigned
Feb 24, 2006
Last updated
Nov 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9101920 FL Primary

Addresses

Primary practice location

636 Del Prado Boulevard
Cape Coral, FL 33990-2695

Mailing address

4131 Matia Dr
Ferndale, WA 98248-9539
Phone (523) 561-2513

Other identifiers 1

IdentifierTypeStateIssuer
291231700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190320002040 WA Practitioner - Physician Assistant 2567411200 Reassigns benefits to 2 organizations
I20241128000028 TX Practitioner - Physician Assistant 2567411200 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth CurrentSince Feb 6, 2019 Accepting new patients
Rosebud Indian Health Service CurrentSince Nov 18, 2024 Accepting new patients
Leeland ER SVCS Partnership LLC Past Accepting new patients
Vero Vascular Surgery PA PastSince Jun 17, 1999 Accepting new patients
Osler Medical Inc Past Accepting new patients
Emcare Physician Providers, Inc. Past Accepting new patients
Gulf Coast Emergency Physicians PA Past Accepting new patients
Emcare Physician Providers, Inc. Past Accepting new patients
Sebastian Hma Physician Management LLC Past Accepting new patients
Harbor Blvd Emergency Physicians, LLC Past Accepting new patients
Omar David Hussamy MD PA PastSince Jul 1, 1999 Accepting new patients
Robert B Ward MD PA Past Accepting new patients
John T Davidson MD FRCS PA Past Accepting new patients

Locations

2901 Squalicum Pkwy
Bellingham, WA 98225
Phone (360) 734-5400

3015 Squalicum Pkwy
Ste 100
Bellingham, WA 98225
Phone (360) 715-4186

3015 Squalicum Pkwy
Ste 200
Bellingham, WA 98225
Phone (360) 733-2092

Organizations & group practices 15

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1033185699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4131 MATIA DR",
            "city": "FERNDALE",
            "state": "WA",
            "postal_code": "982489539",
            "telephone_number": "523-561-2513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 DEL PRADO BOULEVARD",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339902695",
            "telephone_number": "239-424-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKS",
        "first_name": "JONATHAN",
        "middle_name": "CLEON",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291231700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Coral, FL

Sources for this page

Verify at the official NPI Registry.