NPIMap

Individual provider Active NPI

Jonathan L Lake, PAC

  • Surgical Physician Assistant
  • Charlotte, NC
National Provider Identifier
1346283801
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
103630 Issued in NC
Practice address
225 Baldwin Ave
Charlotte, NC 28204-3109
Phone
(704) 376-1605
Fax
(704) 335-8448
NPI assigned
Jun 13, 2006
Last updated
Aug 6, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 103630 NC
Surgical Physician Assistant 363AS0400X 103630 NC Primary

Addresses

Primary practice location

225 Baldwin Ave
Charlotte, NC 28204-3109

Mailing address

225 Baldwin Ave
Charlotte, NC 28204-3109
Phone (704) 376-1605

Other identifiers 1

IdentifierTypeStateIssuer
P00344444OtherRAILROAD MEDICARE

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jlake757621@direct.novanthealth.org
Direct Messaging Address jonathan.lakepac.p1@direct.cnsa.nextgenshare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040729000693 SC Practitioner - Physician Assistant 4688644354 Reassigns benefits to 2 organizations
I20060921000560 NC Practitioner - Physician Assistant 4688644354 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical University of South Carolina College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolina Neurosurgery and Spine Associates PAGroup PAC ID 7214833375, 104 clinicians
Carolina Physical Therapy Associates LLCGroup PAC ID 7012989684, shared by 7 NPIs, 496 clinicians

Practice addresses (Care Compare)

225 Baldwin Ave
Charlotte, NC 28204-3109
Phone (704) 376-1605

271 Old Barn Rd
Hendersonville, NC 28791-8406
Phone (828) 890-4905

3367 N NC 16 Business Hwy
Denver, NC 28037-8265
Phone (419) 221-6717

937 Riverwalk Pkwy
Rock Hill, SC 29730-0178
Phone (803) 325-1618

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
939SCMDAthletic Trainer
103630NCMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Atrium Health Neurospine Network LLC CurrentSince Oct 1, 2025 Accepting new patients
Carolina Neurosurgery & Spine Associates PA CurrentSince Feb 1, 2016 Accepting new patients
Carolina Neurosurgery & Spine Associates PA CurrentSince Feb 1, 2016 Accepting new patients
Atrium Health Neurospine Network LLC CurrentSince Oct 1, 2025 Accepting new patients
South Carolina Emergency Physicians, LLC Past Accepting new patients
Carolina Neurosurgery, PA Past Accepting new patients
York Emergency Physicians Past Accepting new patients
Emergency Physician Specialists Inc Past Accepting new patients

Locations

225 Baldwin Ave
Charlotte, NC 28204
Phone (704) 376-1605

110 Lake Concord Rd NE
Concord, NC 28025
Phone (704) 792-2672

175 Amendment Ave
Ste 104
Rock Hill, SC 29732
Phone (704) 442-4390

937 Riverwalk Pkwy
Rock Hill, SC 29730
Phone (803) 325-1618

937 Riverwalk Pkwy
Ste 101
Rock Hill, SC 29730
Phone (800) 344-6716

Interoperability endpoints

  • FHIR API: https://epicproxy.et0905.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: jlake499516@carolinashealthcaresystem.direct-ci.com
  • Direct secure messaging: jlake757621@direct.novanthealth.org
  • Direct secure messaging: jonathan.lakepac.p1@direct.cnsa.nextgenshare.com

Organizations & group practices 8

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.

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": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1346283801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 BALDWIN AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043109",
            "telephone_number": "704-376-1605",
            "fax_number": "704-335-8448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 BALDWIN AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043109",
            "telephone_number": "704-376-1605",
            "fax_number": "704-335-8448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "JONATHAN",
        "middle_name": "L",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103630",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "103630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00344444",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jlake757621@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "225 Baldwin Ave",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282043109",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jonathan.lakepac.p1@direct.cnsa.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "225 Baldwin Ave",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282043109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.