NPIMap

Individual provider Active NPI

Mellyn Aileen Johnson, APRN

  • Family Nurse Practitioner
  • Reno, NV
National Provider Identifier
1003181926
Registry record updated Apr 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN001367 Issued in NV
Practice address
1500 E 2ND St
Ste 100
Reno, NV 89502-1262
Phone
(775) 982-5003
Fax
(775) 982-5103
NPI assigned
Mar 9, 2012
Last updated
Apr 22, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APRN001367 NV
Family Nurse Practitioner 363LF0000X APRN001367 NV Primary

Addresses

Primary practice location

1500 E 2ND St
Ste 100
Reno, NV 89502-1262

Mailing address

850 Harvard Way
Reno, NV 89502-2055
Phone (775) 982-5262

Other identifiers 2

IdentifierTypeStateIssuer
1003181926MedicaidNV
12368895OtherCAQH

Other names 1

  • Mellyn Aileen Butler Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120816000957 NV Practitioner - Nurse Practitioner 7719133131 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Services LLCGroup PAC ID 1951324318, 630 clinicians

Practice addresses (Care Compare)

1500 E 2ND St
Suite 100
Reno, NV 89502-1189
Phone (775) 982-5003

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.15 of 100Reported as group
Quality
79.09
Promoting interoperability
100
Improvement activities
40
Cost
71.43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN001367NVMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Services LLC CurrentSince May 8, 2012 Accepting new patients
Community Care Services LLC CurrentSince May 8, 2012 Accepting new patients
Community Care Services LLC Nurse Practitioner Current Accepting new patients
Community Care Services LLC Nurse Practitioner Past Accepting new patients

Locations

10315 Professional Cir
Reno, NV 89521
Phone (775) 982-5860

1155 Mill St
Reno, NV 89502
Phone (775) 982-7878

1500 E 2nd St
Ste 100
Reno, NV 89502
Phone (775) 982-5003

850 Harvard Way
Reno, NV 89502

Interoperability endpoints

  • Direct secure messaging: mjohnson98517@direct.renown.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1331251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555891200000",
    "number": "1003181926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 HARVARD WAY",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895022055",
            "telephone_number": "775-982-5262",
            "fax_number": "775-982-5496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E 2ND ST",
            "address_2": "STE 100",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895021262",
            "telephone_number": "775-982-5003",
            "fax_number": "775-982-5103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MELLYN",
        "middle_name": "AILEEN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-09",
        "last_updated": "2019-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NV",
            "license": "APRN001367",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "APRN001367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003181926",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12368895",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELLYN",
            "last_name": "BUTLER",
            "middle_name": "AILEEN",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.