Michael Howard Johnson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA01163 Issued in TX

Practice address

4504 Boat Club Rd Ste 800
Fort Worth, TX 76135-7002

Phone

(817) 237-0515

NPI assigned

Jul 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073533725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9157 STEINER ST",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762486197",
            "telephone_number": "210-392-6186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4504 BOAT CLUB RD STE 800",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761357002",
            "telephone_number": "817-237-0515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MICHAEL",
        "middle_name": "HOWARD",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA01163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Agnes Johnson, NP
• Meagan Anne Johnson, PA-C
• Melinda D Johnson, O.D.
• Melvin Johnson
• Michael Gabriel Johnson
• Michelle Laurane Johnson, NP-C
• Mitchell Johnson
• Mitzie Johnson, LVN
• Morgan Drew Johnson, LMSW
• Nannie Blanche Johnson

• Medical Physician Assistant in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.