Individual provider Active NPI

Jonathan Lenz, PA

  • Physician Assistant
  • Puyallup, WA
National Provider Identifier
1679396436
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA61622584 Issued in WA
Practice address
413 29TH St NE Ste I
Puyallup, WA 98372-7154
Phone
(855) 255-1750
Fax
(855) 255-0905
NPI assigned
Oct 31, 2024
Last updated
Oct 31, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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 PA61622584 WA Primary

Addresses

Primary practice location

413 29TH St NE Ste I
Puyallup, WA 98372-7154

Mailing address

413 29TH St NE Ste I
Puyallup, WA 98372-7154
Phone (855) 255-1750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20241112000000 WA Practitioner - Physician Assistant 7517491749 Reassigns benefits to 1 organization
I20260505003593 ID Practitioner - Physician Assistant 7517491749 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
United Wound Healing PSGroup PAC ID 2860794070, 32 clinicians

Practice addresses (Care Compare)

413 29TH St NE
Suite I
Puyallup, WA 98372-7154
Phone (855) 255-1750

500 S 8TH St
Boise, ID 83702-7107
Phone (855) 255-1750

920 12TH Ave SE
Puyallup, WA 98372-4920
Phone (855) 255-1750

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
United Wound Healing Accountable Care Consultants PLLC Physician Assistant CurrentSince Nov 3, 2024 Accepting new patients

Locations

500 S 8th St
Boise, ID 83702

413 29th St NE
Ste I
Puyallup, WA 98372

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1730332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1679396436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 29TH ST NE STE I",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983727154",
            "telephone_number": "855-255-1750",
            "fax_number": "855-255-0905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 29TH ST NE STE I",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983727154",
            "telephone_number": "855-255-1750",
            "fax_number": "855-255-0905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LENZ",
        "first_name": "JONATHAN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-10-31",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61622584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.