MR. JACOB LEE WONDERLICH (PA) – Physician Assistant, NPI 1255446878
Physician Assistant
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for MR. JACOB LEE WONDERLICH (PA)
8390, ChampionsGate Boulevard, ChampionsGate, Osceola County, Florida, 33896, United States
SUITE 306
CHAMPIONS GATE, FL 33896
Phone: (407) 390-1677
Fax: (407) 390-1765
Type: Mailing
27, Davenport Place, Hempstead, Nassau County, New York, 11710, United States
DAVENPORT, FL 33837
Phone: (863) 422-4971
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 5 Open Payments records for all available years, with a total value of $176.
Total Amount is formed as General ($176) + Research ($0) + Ownership ($0) = $176.
Last reported payment date: 2024-09-21 • Largest payer in this snapshot: ABBVIE INC. ($142).
Total Amount
$176
General + Research + Ownership
Payments
5
Total payment records
General Amount
$176
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-21
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $142 |
| Galderma Laboratories, L.P. | $35 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2006-01-17
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20060117000353 | I | Physician Assistant | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 87804 | Detection test by immunoassay with direct visual observation for influenza virus | 24 | 15 | $0 |
Insurance plans in this area (ZIP 33896)
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