Active NPI
Johnny Michael Jones, PA-C
- Specialist
- Anacortes, WA
National Provider Identifier
1174692198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- PA10004470
- Practice address
- 715 Seafarers Way
Ste 201 B
Anacortes, WA 98221-2257 - Phone
- (360) 588-1460
- Fax
- (360) 588-1473
- NPI assigned
- Nov 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | PA10004470 | WA | Primary |
| Physician Assistant | 363A00000X | 10004470 | WA |
Addresses
Primary practice location
715 Seafarers Way
Ste 201 B
Anacortes, WA 98221-2257
Mailing address
PO Box 1048
Anacortes, WA 98221-1048
Phone (360) 588-1460
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 277551 | Other | WA | STATE OF WA L & I |
| 1174822159 | Medicaid | WA | |
| 1174692198 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10004470 | WA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pacific Rim Headache Center | Physician Assistant | Past | Accepting new patients |
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.
-
- Physician Assistant
- Anacortes, WA
- NPI 1174822159
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314835200000",
"number": "1174692198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1048",
"city": "ANACORTES",
"state": "WA",
"postal_code": "982211048",
"telephone_number": "360-588-1460",
"fax_number": "360-588-1473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 SEAFARERS WAY",
"address_2": "STE 201 B",
"city": "ANACORTES",
"state": "WA",
"postal_code": "982212257",
"telephone_number": "360-588-1460",
"fax_number": "360-588-1473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JONES",
"first_name": "JOHNNY",
"middle_name": "MICHAEL",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-06",
"last_updated": "2011-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "PA10004470",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "10004470",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF WA L & I",
"identifier": "277551",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1174822159",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1174692198",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anacortes, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.