Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jake Michael Johnson, PA

Individual provider Physician Assistant · NPI 1134787518

Jake Michael Johnson, PA is a Physician Assistant in Bridgeport, Connecticut. Qualified in 2019, 7 years ago. Practices with Northeast Medical Group Inc, a 1,360-clinician group and accepts Medicare assignment. Licensed in Connecticut.

Years since qualifying
7
Licensed in
CT
In the registry since
2019
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

267 Grant St
Bridgeport, CT 06610-2805
Phone: (203) 384-3000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 4557 (CT)

Record details

NPI number1134787518
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedMay 31, 2019
Last updated in NPPESAugust 7, 2019
Mailing address21 Vista Dr, Shelton, CT 06484-1696

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Northeast Medical Group Inc — 1360 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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