NPIMap

Individual provider Active NPI

Jonathan Daniel Clemons, PA-C

  • Physician Assistant
  • Olympia, WA
National Provider Identifier
1073006235
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3901 Capital Mall Dr SW Ste a
Olympia, WA 98502-8654
Phone
(360) 868-6259
Fax
(360) 491-6328
NPI assigned
Jun 12, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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 Primary

Addresses

Primary practice location

3901 Capital Mall Dr SW Ste a
Olympia, WA 98502-8654

Mailing address

99 Hawley LN FL 1
Stratford, CT 06614-1204
Phone (475) 321-3239

Other practice location 1

267 Grant St
Bridgeport, CT 06610-2805
Phone (475) 321-3239

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, CT2 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
I20220826000996 WA Practitioner - Physician Assistant 5698159523 Reassigns benefits to 1 organization
I20260210004024 CT Practitioner - Physician Assistant 5698159523 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Medical Group IncGroup PAC ID 1254233836, 1,357 clinicians

Practice addresses (Care Compare)

267 Grant St
Bridgeport, CT 06610-2805
Phone (203) 384-3000

Hospital & facility affiliations

  • Capital Medical Center Hospital, Olympia, WA, CCN 500139
  • Providence St Peter Hospital Hospital, Olympia, WA, CCN 500024
  • Mason General Hospital & Family of Clinics Hospital, Shelton, WA, CCN 501336
  • Bridgeport Hospital Hospital, Bridgeport, CT, CCN 070010
  • Summit Pacific Medical Center Hospital, Elma, WA, CCN 501304

Merit-based Incentive Payment System (MIPS)

Final score
88.86 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
87.45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
7288CTMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Mill Hill Medical Consultants Inc CurrentSince Feb 16, 2026 Accepting new patients
Northeast Medical Group, Inc. CurrentSince Feb 16, 2026 Accepting new patients

Locations

267 Grant St
Bridgeport, CT 06610
Phone (203) 384-3170

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

99 Hawley Ln
Fl 1
Stratford, CT 06614

Interoperability endpoints

  • Direct secure messaging: jonathan.clemons.1@5512.direct.athenahealth.com

Organizations & group practices 3

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

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1528761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1073006235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 HAWLEY LN FL 1",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066141204",
            "telephone_number": "475-321-3239",
            "fax_number": "475-246-9952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 CAPITAL MALL DR SW STE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028654",
            "telephone_number": "360-868-6259",
            "fax_number": "360-491-6328"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "267 Grant St",
            "address_purpose": "LOCATION",
            "city": "Bridgeport",
            "state": "CT",
            "postal_code": "066102805",
            "country_code": "US",
            "telephone_number": "475-321-3239",
            "fax_number": "475-246-9952",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLEMONS",
        "first_name": "JONATHAN",
        "middle_name": "DANIEL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-12",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.