NPIMap

Individual provider Active NPI

Ruth Ann Johnson, CRNP

  • Nurse Practitioner
  • Nazareth, PA
National Provider Identifier
1063781185
Registry record updated Nov 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
SP011678 Issued in PA
Practice address
4059 Jandy Blvd Ste 103
Nazareth, PA 18064-8819
Phone
(484) 503-6450
Fax
(833) 820-1004
NPI assigned
Dec 19, 2011
Last updated
Nov 10, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X SP011678 PA Primary

Addresses

Primary practice location

4059 Jandy Blvd Ste 103
Nazareth, PA 18064-8819

Mailing address

4059 Jandy Blvd Ste 103
Nazareth, PA 18064-8819
Phone (484) 503-6450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20120124000523 PA Practitioner - Nurse Practitioner 0941477491 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
Telehealth
Offers telehealth services
Group practices
Universal Rehabilitation and Fitness, Inc.Group PAC ID 5799741690, 16 clinicians
St Lukes Physician Group IncGroup PAC ID 6709798333, 2,161 clinicians

Practice addresses (Care Compare)

15 -17 Microlab Rd
Suite 101
Livingston, NJ 07039-1623

4059 Jandy Blvd
Suite 103
Nazareth, PA 18064-8893
Phone (484) 503-6450

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.13 of 100Reported as apm
Quality
82.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP011678PAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke's Physician Group, Inc. Current Accepting new patients
St Luke's Physician Group Inc CurrentSince Sep 1, 2017 Accepting new patients
St. Luke's Physician Group, Inc. CurrentSince Sep 1, 2017 Accepting new patients
St. Luke's Physician Group, Inc. Past Accepting new patients

Locations

4311 Easton Ave
Bethlehem, PA 18020
Phone (610) 954-3600

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

305 W North St
Nazareth, PA 18064
Phone (610) 759-2208

4059 Jandy Blvd
Ste 103
Nazareth, PA 18064
Phone (484) 503-6450

Organizations & group practices 5

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 7

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": "1324252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668038400000",
    "number": "1063781185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4059 JANDY BLVD STE 103",
            "city": "NAZARETH",
            "state": "PA",
            "postal_code": "180648819",
            "telephone_number": "484-503-6450",
            "fax_number": "833-820-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4059 JANDY BLVD STE 103",
            "city": "NAZARETH",
            "state": "PA",
            "postal_code": "180648819",
            "telephone_number": "484-503-6450",
            "fax_number": "833-820-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "RUTH",
        "middle_name": "ANN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-19",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP011678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nazareth, PA

Sources for this page

Verify at the official NPI Registry.