NPIMap

Individual provider Active NPI

Brett C Johnson, D.O.

  • Family Medicine Physician
  • Travis Afb, CA
National Provider Identifier
1023337185
Registry record updated Oct 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
O-0729 Issued in ID
Practice address
101 Bodin Cir
Travis Afb, CA 94535-1809
Phone
(707) 423-3383
NPI assigned
May 27, 2010
Sex
Male
Sole proprietor
Yes

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 and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nevada School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Lukes Clinic-Treasure Valley LLC 1,155 clinicians

Practice addresses (Care Compare)

1210 NW 16TH St
Fruitland, ID 83619-2202
Phone (208) 452-8600

3950 17TH St
Baker City, OR 97814-1300
Phone (541) 523-1001

Hospital & facility affiliations

  • Horizon Home Health West Home health agency, Caldwell, ID, CCN 137135
  • Canyon Home Care & Hospice Home health agency, Fruitland, ID, CCN 137068
  • Enhabit Home Health & Hospice Hospice, Boise, ID, CCN 131507
  • Horizon Hospice West Hospice, Caldwell, ID, CCN 131510
  • Enhabit Hospice of Idaho Hospice, Fruitland, ID, CCN 131540
  • Aarondale Hospice Hospice, Meridian, ID, CCN 131594
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • Saint Alphonsus Medical Center Ontario Hospital, Ontario, OR, CCN 380052
  • St Luke'S Nampa Medical Center Hospital, Nampa, ID, CCN 130071
  • Pioneer Nursing Home Nursing home, Vale, OR, CCN 385273

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy18
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of skin lesions1-10

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

All facility ownership & control disclosures 2

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Enhabit Hospice of IdahoFruitland, ID, CCN 131540 Hospice W-2 Managing Employee Oct 1, 2023
Aarondale Hospice LLCMeridian, ID, CCN 131594 Hospice Contracted Managing Employee Aug 15, 2024

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20170113001330 ID Practitioner - Family Practice 1850580721 Reassigns benefits to 1 organization
I20180529003124 OR Practitioner - Family Practice 1850580721 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A13693CAMDEmergency Medicine Physician
13693CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC Emergency Medicine CurrentSince Dec 28, 2016 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

1210 NW 16th St
Fruitland, ID 83619
Phone (208) 452-8600

3950 17th St
Baker City, OR 97814
Phone (541) 523-1001

Interoperability endpoints

  • Direct secure messaging: bjohnson83507@direct.slhs.org

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X O-0729 ID Primary
Emergency Medicine Physician 207P00000X 20A13693 CA

Addresses

NPPES NPI Registry

Primary practice location

101 Bodin Cir
Travis Afb, CA 94535-1809

Mailing address

101 Bodin Cir
Travis Afb, CA 94535-1809
Phone (707) 423-3383

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 25, 2016.

{
    "created_epoch": "1274918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477353600000",
    "number": "1023337185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-3383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-3383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BRETT",
        "middle_name": "C",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-05-27",
        "last_updated": "2016-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-0729",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "20A13693",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Travis Afb, CA

Sources for this page

Verify at the official NPI Registry.