Jonathan Anthony Shomo, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110002842 Issued in VA

Practice address

110A N Main St
Bridgewater, VA 22812-1301

Phone

(540) 515-4325

Fax

(540) 210-1271

NPI assigned

Sep 3, 2008

Sex

Male

Sole proprietor

Yes

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2021 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Hastings Healthcare, LLC

  dba Heastings Medical Clinic of Bridgewater

  • General Practice Physician
  • Bridgewater, VA
  • NPI 1225637242
  NPD Authorized official
• University of Virginia Physicians Group

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Charlottesville, VA
  • NPI 1033138250
  NPD (past)

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1689822652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110A N MAIN ST",
            "city": "BRIDGEWATER",
            "state": "VA",
            "postal_code": "228121301",
            "telephone_number": "540-515-4325",
            "fax_number": "540-210-1271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110A N MAIN ST",
            "city": "BRIDGEWATER",
            "state": "VA",
            "postal_code": "228121301",
            "telephone_number": "540-515-4325",
            "fax_number": "540-210-1271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOMO",
        "first_name": "JONATHAN",
        "middle_name": "ANTHONY",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-03",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110002842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689822652",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sapphire Valley Wellness Center, LLC
• Rodney Terence Scott Jr.
• Rayah Secrist
• Sentara Advanced Imaging Solutions, LLC (Sentara Advanced Imaging Solutions)
• Danielle Q. Shannon
• Melony Shumaker
• Rebecca L Smith
• Richard M. Smith
• Olivia Stieler
• Madison Taylor Streett

• Medical Physician Assistant in Bridgewater, VA
• Providers in Bridgewater, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.