Alicia Renee Johnson, P.A

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.003097RX Issued in OH

Practice address

98 State St
Proctorville, OH 45669-8163

Phone

(740) 886-9370

Fax

(740) 886-9374

NPI assigned

Aug 18, 2010

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Holzer Clinic LLCGroup PAC ID 5890606008, 266 clinicians

Premier Therapy and Health Centers IncGroup PAC ID 7416859574, shared by 6 NPIs, 263 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Mary'S Home Health Service Home health agency, Proctorville, OH, CCN 368269
• St Marys Medical Center Hospital, Huntington, WV, CCN 510007
• Cabell Huntington Hospital, Inc Hospital, Huntington, WV, CCN 510055

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: alicia.johnson.1@17389.direct.athenahealth.com

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.

• Holzer Clinic, LLC

  • Multi-Specialty Clinic/Center
  • Gallipolis, OH
  • NPI 1508817248
  Medicare reassignment Care Compare group
• I Path LLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Gallipolis, OH
  • NPI 1942525563
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St. Mary'S Medical Center Home Health Services, LLC

  • Home Health Agency
  • Proctorville, OH
  • NPI 1013109560
  Care Compare affiliation
• Cabell Huntington Hospital Inc

  • General Acute Care Hospital
  • Huntington, WV
  • NPI 1073518007
  Care Compare affiliation
• St. Mary'S Medical Center Inc

  • General Acute Care Hospital
  • Huntington, WV
  • NPI 1164492195
  Care Compare affiliation

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

{
    "created_epoch": "1282089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1134434830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 JACKSON PIKE",
            "city": "GALLIPOLIS",
            "state": "OH",
            "postal_code": "456311560",
            "telephone_number": "740-886-9370",
            "fax_number": "740-886-9374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 STATE ST",
            "city": "PROCTORVILLE",
            "state": "OH",
            "postal_code": "456698163",
            "telephone_number": "740-886-9370",
            "fax_number": "740-886-9374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ALICIA",
        "middle_name": "RENEE",
        "credential": "P.A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-18",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.003097RX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0095884",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00914836",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "alicia.johnson.1@17389.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "98 State St",
            "city": "Proctorville",
            "state": "OH",
            "country_code": "US",
            "postal_code": "456698163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Glen P. Imlay, M.D.
• Ironton & Lawrence County Area Community Action Organization
• Ironton & Lawrence County Area Community Action Organization
• Philip William Isgett, R.PH.
• Paul Ives, PHARMD
• Joseph Johnson
• Brittany Kerns
• Tamela R. King, C-FNP
• Kroger Limited Partnership I
• Thomas Lambiotte, P.T.

• Physician Assistant in Proctorville, OH
• Providers in Proctorville, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.