{"npi":"1407930456","type":"NPI-1","status":"active","name":{"display":"Jon Mortensen Pac","other":[],"first":"JON","last":"MORTENSEN","middle":"DERIK","credential":"PAC"},"specialty":{"primary_taxonomy":"363AM0700X","primary_taxonomy_description":"Medical Physician Assistant","slug":"medical-physician-assistant","schema_org_specialty":null,"all":[{"code":"363AM0700X","description":"Medical Physician Assistant","primary":true,"state":"WA","license":"PA10005073"}]},"addresses":[{"purpose":"LOCATION","street_1":"10510 GRAVELLY LAKE DR.","city":"LAKEWOOD","state":"WA","postal_code":"98499","country_code":"US","street_2":"COMMUNITY HEALTH CARE - LAKEWOOD CLINIC","phone":"2535897030","fax":"2535897033"},{"purpose":"MAILING","street_1":"1019 PACIFIC AVE STE 300","city":"TACOMA","state":"WA","postal_code":"984024488","country_code":"US","street_2":"ATTN HR","phone":"2537221540"}],"license":{"state":"WA","number":"PA10005073"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"8469256","state":"WA","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20070115000277","type_code":"14-97","type_desc":"PRACTITIONER - PHYSICIAN ASSISTANT","state":"WA","pac_id":"7618977703"}]},"enumeration_date":"2006-10-25","last_updated":"2012-06-14","_meta":{"source":"NPPES","snapshot_date":"2012-06-14","doc_url":"https://findmynpi.com/api"}}