Idella Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

670 Issued in TN

Practice address

1610 Tazewell Rd
Suite 201
Tazewell, TN 37879-3600

Phone

(423) 626-8393

Fax

(423) 626-8749

NPI assigned

Jun 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

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

Practice roles

Locations

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.

• Covenant Medical Group, Inc.

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1457302010

  Physician Assistant

  Medicare reassignment NPD
• Covenant Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Knoxville, TN
  • NPI 1871269415
  NPD
• Multispecialty Medical P.C.

  • Internal Medicine Physician
  • Tazewell, TN
  • NPI 1548392491
  NPD (past)

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450224000000",
    "number": "1073554523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 TAZEWELL RD",
            "address_2": "SUITE 201",
            "city": "TAZEWELL",
            "state": "TN",
            "postal_code": "378793600",
            "telephone_number": "423-626-8393",
            "fax_number": "423-626-8749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 TAZEWELL RD",
            "address_2": "SUITE 201",
            "city": "TAZEWELL",
            "state": "TN",
            "postal_code": "378793600",
            "telephone_number": "423-626-8393",
            "fax_number": "423-626-8749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "IDELLA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2015-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3669471",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TENNESSEE",
            "identifier": "4058153",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Home Town Pharmacy Inc.
• Olivia Hoskins, RDN, LDN
• Amy Howe, NP-C
• Heather Hunley, FNP-BC
• IHS Acquisition Xxvii Inc
• Jordan Chiropractic
• Courtney Joyce, SPEECH PATHOLOGIST
• JS Patel MD PC
• K-VA-T Food Stores Inc
• Kathy Payne Kelley, PHARMD

• Physician Assistant in Tazewell, TN
• Providers in Tazewell, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; 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.