Individual provider Active NPI

Jonathan W. Ponte, NP

  • Adult Health Nurse Practitioner
  • Worcester, MA
National Provider Identifier
1174811343
Registry record updated Jul 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
RN2264431 Issued in MA
Practice address
123 Summer St
Suite 320
Worcester, MA 01608-1216
Phone
(508) 368-3140
Fax
(508) 368-3143
NPI assigned
Jul 21, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X RN2264431 MA Primary

Addresses

Primary practice location

123 Summer St
Suite 320
Worcester, MA 01608-1216

Mailing address

630 Plantation St
Wot 12TH FL
Worcester, MA 01605-2038
Phone (508) 368-5424

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20111110000799 MA Practitioner - Nurse Practitioner 3577737410 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Reliant Medical Group IncGroup PAC ID 5597755322, 638 clinicians

Practice addresses (Care Compare)

123 Summer St
Worcester, MA 01608-1216
Phone (508) 363-5000

24 Newton St
Southborough, MA 01772-1215
Phone (508) 486-4472

5 Neponset St
Worcesteer, MA 01606-2714
Phone (508) 595-2300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Reliant Medical Group, Inc CurrentSince Sep 19, 2011 Accepting new patients
Reliant Medical Group, Inc Past Accepting new patients

Locations

630 Plantation St
Fl 12
Worcester, MA 01605
Phone (508) 368-5529

123 Summer St
Ste 370N
Worcester, MA 01608
Phone (508) 363-7300

123 Summer St
Ste 320
Worcester, MA 01608
Phone (508) 368-3140

5 Neponset St
Worcester, MA 01606
Phone (508) 595-2300

Interoperability endpoints

  • Direct secure messaging: jonathan.ponte.npi1174811343.reliant@direct.optumcare.masshiway.net

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.

NPI Registry JSON

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

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311206400000",
    "number": "1174811343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 PLANTATION ST",
            "address_2": "WOT 12TH FL",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052038",
            "telephone_number": "508-368-5424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 SUMMER ST",
            "address_2": "SUITE 320",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016081216",
            "telephone_number": "508-368-3140",
            "fax_number": "508-368-3143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONTE",
        "first_name": "JONATHAN",
        "middle_name": "W.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-21",
        "last_updated": "2011-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "RN2264431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.