Individual provider Active NPI

Steven Boyd Johnson, PA-C

  • Medical Physician Assistant
  • Bentonville, AR
National Provider Identifier
1104101716
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA-457 Issued in AR
Practice address
3101 SE 14TH St
Bentonville, AR 72712-4900
Phone
(479) 250-1053
Fax
(479) 250-0923
NPI assigned
Oct 14, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA-457 AR Primary

Addresses

Primary practice location

3101 SE 14TH St
Bentonville, AR 72712-4900

Mailing address

PO Box 775641
Chicago, IL 60677-6084
Phone (479) 250-1053

Other practice location 1

1673 N College Ave
Fayetteville, AR 72703-1919
Phone (479) 521-0200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address steven.johnson@mana.eclinicaldirectplus.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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

Enrollment IDStateProvider typePAC IDDetails
I20120326000013 AR Practitioner - Physician Assistant 4082874326 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwest Benton County Physician Services LLCGroup PAC ID 3577503689, 36 clinicians

Practice addresses (Care Compare)

101 Sun Meadow Dr
Centerton, AR 72719-9610
Phone (479) 795-0426

2900 Medical Ctr Pkwy
Bentonville, AR 72712-3214

3000 Medical Ctr Pkwy
Bentonville, AR 72712-3217
Phone (479) 757-8099

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-457ARMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Associates of Northwest Arkansas PA Past Accepting new patients
Mercy Health Northwest Arkansas Communities Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: steven.johnson.6@2229.direct.athenahealth.com
  • Direct secure messaging: steven.johnson@mana.eclinicaldirectplus.com

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1318550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1104101716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 775641",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776084",
            "telephone_number": "479-250-1053",
            "fax_number": "479-250-0923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 SE 14TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727124900",
            "telephone_number": "479-250-1053",
            "fax_number": "479-250-0923"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1673 N College Ave",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "727031919",
            "country_code": "US",
            "telephone_number": "479-521-0200",
            "fax_number": "479-521-4942",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "STEVEN",
        "middle_name": "BOYD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-14",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AR",
            "license": "PA-457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "steven.johnson@mana.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "steven.johnson@mana.eclinicaldirectplus.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1673 N College Ave",
            "city": "Fayetteville",
            "state": "AR",
            "country_code": "US",
            "postal_code": "727031919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

Verify at the official NPI Registry.