Jacob Lee Wonderlich, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9103414 Issued in FL

Practice address

40100 Highway 27
Davenport, FL 33837

Phone

(863) 422-4971

NPI assigned

Aug 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacob.wonderlich.1@26755.direct.athenahealth.com

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

• FL-I Medical Services LLC

  • Physician Assistant
  • Haines City, FL
  • NPI 1285356790
  NPD
• FL-I Medical Services LLC

  • Emergency Medicine Physician
  • St Petersburg, FL
  • NPI 1831508217

  Physician Assistant

  NPD
• Advance Technological Radiology, PA

  • Diagnostic Radiology Physician
  • Davenport, FL
  • NPI 1154450351
  NPD (past)
• Clover Emergency Physicians LLC

  • Emergency Medicine Physician
  • St Petersburg, FL
  • NPI 1891744736
  NPD (past)
• Emergency Physician Specialists Inc

  • Emergency Medicine Physician
  • Davenport, FL
  • NPI 1912973850
  NPD (past)
• Florida Em-I Medical Services PA

  • Emergency Medicine Physician
  • Lakeland, FL
  • NPI 1871542720
  NPD (past)
• Guidewell Emergency Medicine Doctors, LLC

  dba GuideWell Emergency Medicine Doctors Imaging

  • Radiology Clinic/Center
  • Winter Park, FL
  • NPI 1639973555
  NPD (past)
• Osprey Emergency Physicians LLC

  • Emergency Medicine Physician
  • Lakeland, FL
  • NPI 1063461960
  NPD (past)

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1255446878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8390 CHAMPIONS GATE BOULEVARD",
            "address_2": "SUITE 306",
            "city": "CHAMPIONS GATE",
            "state": "FL",
            "postal_code": "33896",
            "telephone_number": "407-390-1677",
            "fax_number": "407-390-1765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40100 HIGHWAY 27",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "33837",
            "telephone_number": "863-422-4971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONDERLICH",
        "first_name": "JACOB",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9103414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292248700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Wiggins
• Monica Faye Williams, APRN
• Paul David Williams, M.D.
• Amensha Willix
• Meghan Wills, PT, DPT
• Howard Lawrence Wray
• Lisa Valerie Wright, NP
• Shannon Lea Wright, PHARMD, BCCCP
• Margaret Rose Yee, M.D.
• Donald Harrison Youmans, M.D.

• Physician Assistant in Davenport, FL
• Providers in Davenport, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.