Active NPI
Charles E Johnson, PA-C
- Physician Assistant
- Pahrump, NV
National Provider Identifier
1124090949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA-C0149
- Practice address
- 1501 E Calvada Blvd
Pahrump, NV 89048-5807 - Phone
- (775) 727-5509
- Fax
- (775) 727-5696
- NPI assigned
- Feb 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-C0149 | NV | Primary |
Addresses
Primary practice location
1501 E Calvada Blvd
Pahrump, NV 89048-5807
Mailing address
PO Box 98978
Las Vegas, NV 89193-8978
Phone (702) 507-2419
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00865044 | Other | NV | RAILROAD MEDICARE |
| 1124090949 | Medicaid | NV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 562 | NV | MD | General Practice Dentistry |
| PA-C0149 | NV | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced House Calls Inc | Past | Accepting new patients | |
| A Better Option Healthcare Inc | Past | Accepting new patients | |
| Intermountain Medical Holdings Nevada Inc | Past | Accepting new patients |
Organizations & group practices 3
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.
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- NPI 1285155325
-
- Specialist
- Las Vegas, NV
- NPI 1295732451
-
- Internal Medicine Physician
- Henderson, NV
- NPI 1245997279
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327449600000",
"number": "1124090949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 98978",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891938978",
"telephone_number": "702-507-2419",
"fax_number": "702-671-6883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 E CALVADA BLVD",
"city": "PAHRUMP",
"state": "NV",
"postal_code": "890485807",
"telephone_number": "775-727-5509",
"fax_number": "775-727-5696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "CHARLES",
"middle_name": "E",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-06",
"last_updated": "2012-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NV",
"license": "PA-C0149",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00865044",
"state": "NV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1124090949",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pahrump, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.