NPIMap

Individual provider Active NPI

Jared B Cornelison, PA-C

  • Physician Assistant
  • Olympia, WA
National Provider Identifier
1093068595
Registry record updated May 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60360929 Issued in WA
Practice address
3901 Capital Mall Dr SW
Ste a
Olympia, WA 98502-1178
Phone
(360) 786-8990
Fax
(360) 786-9010
NPI assigned
Oct 22, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2026

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 PA60360929 WA Primary

Addresses

Primary practice location

3901 Capital Mall Dr SW
Ste a
Olympia, WA 98502-1178

Mailing address

PO Box 368
Olympia, WA 98507-0368
Phone (360) 455-5144

Other practice location 1

3901 Capital Mall Dr SW Ste B
Olympia, WA 98502-8654
Phone (360) 528-8571

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130627000795 WA Practitioner - Physician Assistant 8022262013 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Olympia Orthopaedic Associates PLLCGroup PAC ID 2365337508, 87 clinicians

Practice addresses (Care Compare)

3901 Capital Mall Dr SW
Olympia, WA 98502-8654

615 Lilly Rd NE
Olympia, WA 98506-5117
Phone (360) 491-4211

Hospital & facility affiliations

  • Providence St Peter Hospital Hospital, Olympia, WA, CCN 500024
  • Mason General Hospital & Family of Clinics Hospital, Shelton, WA, CCN 501336
  • Summit Pacific Medical Center Hospital, Elma, WA, CCN 501304
  • Grays Harbor Community Hospital Hospital, Aberdeen, WA, CCN 500031
  • Capital Medical Center Hospital, Olympia, WA, CCN 500139

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
PA60360929WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Olympia Orthopaedic Associates, PLLC CurrentSince Jun 15, 2013 Accepting new patients
Olympia Orthopaedic Associates PLLC CurrentSince Jun 15, 2013 Accepting new patients

Locations

3901 Capital Mall Dr SW
Ste B
Olympia, WA 98502
Phone (360) 528-8571

615 Lilly Rd NE
Ste 240
Olympia, WA 98506
Phone (360) 413-3850

3901 Capital Mall Dr SW
Ste C
Olympia, WA 98502
Phone (360) 709-6223

3901 Capital Mall Dr SW
#A
Olympia, WA 98502
Phone (360) 570-3460

615 Lilly Rd NE
Ste 100
Olympia, WA 98506
Phone (360) 491-4211

Interoperability endpoints

  • Direct secure messaging: jared.cornelison.1@5512.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/5512/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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 10

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": "1350864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779840000000",
    "number": "1093068595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 368",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985070368",
            "telephone_number": "360-455-5144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 CAPITAL MALL DR SW",
            "address_2": "STE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985021178",
            "telephone_number": "360-786-8990",
            "fax_number": "360-786-9010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3901 Capital Mall Dr SW Ste B",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985028654",
            "country_code": "US",
            "telephone_number": "360-528-8571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORNELISON",
        "first_name": "JARED",
        "middle_name": "B",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-22",
        "last_updated": "2026-05-27",
        "certification_date": "2026-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60360929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.