Individual provider Active NPI

Jonathan Leong, PA-C

  • Physician Assistant
  • Atwater, CA
National Provider Identifier
1366058158
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
57762 Issued in CA
Practice address
1775 3Rd St
Atwater, CA 95301-3608
Phone
(209) 358-5611
NPI assigned
Sep 17, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 57762 CA Primary

Addresses

Primary practice location

1775 3Rd St
Atwater, CA 95301-3608

Mailing address

220 12TH Ave
San Francisco, CA 94118-2104
Phone (650) 430-0081

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jonathan-leong@atwatermedical.e-mdsdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20240821000403 CA Practitioner - Physician Assistant 3375081474 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57762CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Centers of America CurrentSince Jul 1, 2024 Accepting new patients

Locations

5320 State Highway 49 N
Ste 13
Mariposa, CA 95338
Phone (209) 966-2344

850 W Olive Ave
#A
Merced, CA 95348
Phone (209) 384-1777

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": "1600300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1366058158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 12TH AVE",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941182104",
            "telephone_number": "650-430-0081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 3RD ST",
            "city": "ATWATER",
            "state": "CA",
            "postal_code": "953013608",
            "telephone_number": "209-358-5611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEONG",
        "first_name": "JONATHAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-17",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "57762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jonathan-leong@atwatermedical.e-mdsdirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1775 3rd St",
            "city": "Atwater",
            "state": "CA",
            "country_code": "US",
            "postal_code": "953013608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atwater, CA

Sources for this page

Verify at the official NPI Registry.