Individual provider Active NPI

Jonathan Stephens, PA-C

  • Surgical Physician Assistant
  • Conway, SC
National Provider Identifier
1114535077
Registry record updated Sep 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
6378 Issued in SC
Practice address
2376 Cypress Cir Ste 300
Conway, SC 29526-8995
Phone
(843) 347-8041
NPI assigned
Jul 16, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 025354 NY
Surgical Physician Assistant 363AS0400X 6378 SC Primary

Addresses

Primary practice location

2376 Cypress Cir Ste 300
Conway, SC 29526-8995

Mailing address

300 Singleton Ridge Rd
Att PNS Credentialing
Conway, SC 29526-9142
Phone (843) 234-6996

Other practice location 1

6010 Highway 707 Ste 300
Myrtle Beach, SC 29588-7321
Phone (843) 347-8041

Other identifiers 1

IdentifierTypeStateIssuer
8975PAMedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200929001443 NY Practitioner - Physician Assistant 4385063122
I20240531003912 GA Practitioner - Physician Assistant 4385063122 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
May accept Medicare assignment
Group practices
RST Advancement Florida LLCGroup PAC ID 3577914704, 2 clinicians

Practice addresses (Care Compare)

1015 Arthur J Moore
St Simons, GA 31522-2206

1015 Arthur J Moore Dr
St Simons Is, GA 31522-2206
Phone (912) 694-0023

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
025354NYMDGeneral Practice Dentistry

Interoperability endpoints

  • Direct secure messaging: jonathan.stephens.1@30576.direct.athenahealth.com
  • Direct secure messaging: jstephens789200@direct.trinity-health.org

Organizations & group practices 1

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 1

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": "1594857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789430400000",
    "number": "1114535077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE RD",
            "address_2": "ATT PNS CREDENTIALING",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269142",
            "telephone_number": "843-234-6996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2376 CYPRESS CIR STE 300",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268995",
            "telephone_number": "843-347-8041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6010 Highway 707 Ste 300",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295887321",
            "country_code": "US",
            "telephone_number": "843-347-8041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEPHENS",
        "first_name": "JONATHAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-16",
        "last_updated": "2026-09-15",
        "certification_date": "2026-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "025354",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SC",
            "license": "6378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8975PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

Verify at the official NPI Registry.