Individual provider Active NPI

Jonathan Daniel Palmer, PA

  • Physician Assistant
  • Ephrata, PA
National Provider Identifier
1902455538
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA060946 Issued in PA
Practice address
804 Grandview Dr Ste 2
Ephrata, PA 17522-1681
Phone
(717) 466-2500
Fax
(717) 733-7865
NPI assigned
Sep 6, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA060946 PA
Physician Assistant 363A00000X MA060946 PA Primary

Addresses

Primary practice location

804 Grandview Dr Ste 2
Ephrata, PA 17522-1681

Mailing address

3421 Concord Rd
York, PA 17402-9001
Phone (717) 738-5632

Other practice location 1

2700 Southampton Rd
Philadelphia, PA 19154-1212
Phone (215) 856-5900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20191223000349 PA Practitioner - Physician Assistant 2466783931 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellspan Medical GroupGroup PAC ID 1951213115, 2,438 clinicians

Practice addresses (Care Compare)

169 Martin Ave
Ephrata, PA 17522-1724
Phone (717) 733-0311

175 Martin Ave
Ephrata, PA 17522-1763

25 Monument Rd
York, PA 17403-5073

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA060946PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group CurrentSince Nov 11, 2019 Accepting new patients
Wellspan Medical Group CurrentSince Nov 11, 2019 Accepting new patients

Locations

804 Grandview Dr
Ste 2
Ephrata, PA 17522
Phone (717) 466-2500

169 Martin Ave
Ephrata, PA 17522
Phone (717) 733-0311

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

3421 Concord Rd
York, PA 17402
Phone (717) 851-2441

1600 S George St
York, PA 17403
Phone (717) 848-3615

Interoperability endpoints

  • Direct secure messaging: jpalmer192314@wellspan.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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": "1567728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1902455538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 CONCORD RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174029001",
            "telephone_number": "717-738-5632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 GRANDVIEW DR STE 2",
            "city": "EPHRATA",
            "state": "PA",
            "postal_code": "175221681",
            "telephone_number": "717-466-2500",
            "fax_number": "717-733-7865"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2700 Southampton Rd",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191541212",
            "country_code": "US",
            "telephone_number": "215-856-5900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PALMER",
        "first_name": "JONATHAN",
        "middle_name": "DANIEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-06",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA060946",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA060946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ephrata, PA

Sources for this page

Verify at the official NPI Registry.