Individual provider Active NPI

Richard Lee Johnson, PAC

  • Physician Assistant
  • Dallas, TX
National Provider Identifier
1104848555
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA00053 Issued in TX
Practice address
3500 Gaston Ave
Dallas, TX 75246-2017
Phone
(214) 820-2505
Fax
(214) 712-2487
NPI assigned
Jul 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA00053 TX Primary

Addresses

Primary practice location

3500 Gaston Ave
Dallas, TX 75246-2017

Mailing address

PO Box 41633
Philadelphia, PA 19101-1633
Phone (800) 355-0808

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20110120000286 TX Practitioner - Physician Assistant 7315126521 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Texas Southwestern Medical School at Dallas, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hunt Regional Urgent CareGroup PAC ID 1850729682, 31 clinicians

Practice addresses (Care Compare)

2800 State Hwy 24
Suite C
Commerce, TX 75428-2017
Phone (903) 886-1055

3206 Interstate 30
Suite B
Greenville, TX 75402-7002
Phone (903) 408-7979

5000 E Interstate Hwy 30
Suite 120
Fate, TX 75189-8848
Phone (469) 580-0338

576 W Interstate 30
Royse City, TX 75189-7538
Phone (469) 351-0100

810 E Ralph Hall Pkwy
Suite 100
Rockwall, TX 75032-6879
Phone (469) 402-3400

Hospital & facility affiliations

  • Hunt Regional Medical Center Hospital, Greenville, TX, CCN 450352

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA00053TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Plano Urgent Care LLC PastSince Jul 1, 2014 Accepting new patients
Dallas Emergency Physicians PLLC Past Accepting new patients
Texas Em-I Medical Services, P.a. Past Accepting new patients

Organizations & group practices 6

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": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104848555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41633",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191011633",
            "telephone_number": "800-355-0808",
            "fax_number": "214-712-2487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 GASTON AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752462017",
            "telephone_number": "214-820-2505",
            "fax_number": "214-712-2487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "RICHARD",
        "middle_name": "LEE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA00053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.