Individual provider Active NPI

Achim Deon Johnson, PT,DPT

  • Physical Therapist
  • Deland, FL
National Provider Identifier
1134838865
Registry record updated Feb 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1370684 Issued in TX
Practice address
324 W Victoria Trails Blvd
Deland, FL 32724-8853
Phone
(386) 589-6406
NPI assigned
Nov 21, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT39461 FL
Physical Therapist 225100000X 1370684 TX Primary

Addresses

Primary practice location

324 W Victoria Trails Blvd
Deland, FL 32724-8853

Mailing address

PO Box 603
Deland, FL 32721-0603
Phone (386) 589-6406

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231120001293 TX Practitioner - Physical Therapist in Private Practice 7012365786 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Luna Care Physical Therapy LLCGroup PAC ID 0648692723, 271 clinicians

Practice addresses (Care Compare)

180 State St
Suite 225
Southlake, TX 76092-7632
Phone (866) 525-3175

Merit-based Incentive Payment System (MIPS)

Final score
84.26 of 100Reported as group
Quality
89.74
Improvement activities
40
Cost
61.81

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT39461FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Luna Care Physical Therapy LLC Physical Therapist CurrentSince Nov 6, 2023 Accepting new patients
Powerback Rehabilitation LLC Physical Therapist CurrentSince Dec 5, 2023 Accepting new patients
Powerback Rehabilitation LLC Physical Therapist CurrentSince Dec 5, 2023 Accepting new patients

Locations

7801 N Richland Blvd
North Richlnd Hls, TX 76180
Phone (469) 609-9044

180 State St
Ste 225
Southlake, TX 76092
Phone (682) 429-7066

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.

NPI Registry JSON

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

{
    "created_epoch": "1668988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677024000000",
    "number": "1134838865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327210603",
            "telephone_number": "386-589-6406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 W VICTORIA TRAILS BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327248853",
            "telephone_number": "386-589-6406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ACHIM",
        "middle_name": "DEON",
        "credential": "PT,DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-11-21",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT39461",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1370684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.