Active NPI
Jonathan David Hickman
- Internal Medicine Physician
- Bremerton, WA
National Provider Identifier
1750900304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 0102206735
- Practice address
- 1 Boone Rd
Bremerton, WA 98312-1898 - Phone
- (360) 475-5070
- NPI assigned
- Apr 14, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | 0102206735 | VA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Internal Medicine Physician | 207R00000X | 0102206735 | VA | Primary |
Addresses
Primary practice location
1 Boone Rd
Bremerton, WA 98312-1898
Mailing address
1 Boone Rd
Bremerton, WA 98312-1894
Phone (360) 475-5070
Other practice location 1
NMCP 620 John Paul Jones Cir.
BLDG 3
Portsmouth, VA 23708
Phone (757) 953-2339
Other practice location 2
Naval Hospital Yokosuka Japan
PSC 475 Bx1
Fpo, AP 96350-1200
Phone (046) 816-7144
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211130001304 | VA | Order and Referring Only - Internal Medicine | 5597155861 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752624000000",
"number": "1750900304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 BOONE RD",
"city": "BREMERTON",
"state": "WA",
"postal_code": "983121894",
"telephone_number": "360-475-5070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BOONE RD",
"city": "BREMERTON",
"state": "WA",
"postal_code": "983121898",
"telephone_number": "360-475-5070"
}
],
"practiceLocations": [
{
"address_1": "NMCP 620 John Paul Jones Cir.",
"address_2": "BLDG 3",
"address_purpose": "LOCATION",
"city": "Portsmouth",
"state": "VA",
"postal_code": "23708",
"country_code": "US",
"telephone_number": "757-953-2339",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "Naval Hospital Yokosuka Japan",
"address_2": "PSC 475 Bx1",
"address_purpose": "LOCATION",
"city": "FPO",
"state": "AP",
"postal_code": "963501200",
"country_code": "US",
"telephone_number": "046-816-7144",
"country_name": "United States",
"address_type": "MIL"
}
],
"basic": {
"last_name": "HICKMAN",
"first_name": "JONATHAN",
"middle_name": "DAVID",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-04-14",
"last_updated": "2025-07-16",
"certification_date": "2025-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": "VA",
"license": "0102206735",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "VA",
"license": "0102206735",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bremerton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; 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.