Individual provider Active NPI

Michelle Deon Johnson

  • Gerontology Nurse Practitioner
  • St George, UT
National Provider Identifier
1134999568
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
6819302-4405 Issued in UT
Practice address
617 E Riverside Dr Ste 301
St George, UT 84790-8722
Phone
(435) 216-7000
Fax
(435) 216-7001
NPI assigned
Jan 5, 2024
Last updated
Jan 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 6819302-4405 UT Primary

Addresses

Primary practice location

617 E Riverside Dr Ste 301
St George, UT 84790-8722

Mailing address

617 E Riverside Dr Ste 301
St George, UT 84790-8722
Phone (435) 216-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, NV2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240130001260 UT Practitioner - Nurse Practitioner 0244683969 Reassigns benefits to 1 organization
I20240731003438 NV Practitioner - Nurse Practitioner 0244683969 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Desert Pain Specialists LLCGroup PAC ID 3072683051, 18 clinicians

Practice addresses (Care Compare)

340 Falcon Ridge Pkwy
Suite 603
Mesquite, NV 89027-8852
Phone (702) 346-5037

617 E Riverside Dr
Suite 301
Saint George, UT 84790-8722
Phone (435) 216-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
6819302-4405UTMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Pain Specialists, LLC CurrentSince Jan 10, 2024 Accepting new patients

Locations

340 Falcon Ridge Pkwy
Mesquite, NV 89027
Phone (435) 628-3606

340 Falcon Ridge Pkwy
Ste 603
Mesquite, NV 89027
Phone (702) 346-5037

1000 N Main St
Ste C
Richfield, UT 84701
Phone (435) 238-7000

617 E Riverside Dr
Ste 301
St George, UT 84790
Phone (435) 216-7000

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1704412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1134999568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 E RIVERSIDE DR STE 301",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847908722",
            "telephone_number": "435-216-7000",
            "fax_number": "435-216-7001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 E RIVERSIDE DR STE 301",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847908722",
            "telephone_number": "435-216-7000",
            "fax_number": "435-216-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MICHELLE",
        "middle_name": "DEON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-05",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "UT",
            "license": "6819302-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St George, UT

Sources for this page

Verify at the official NPI Registry.