Timothy W Johnson, MS PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

592 Issued in AK

Practice address

33280 Stoney Creek Ave
Seward, AK 99664-3633

Phone

(907) 224-7094

Fax

(907) 224-7094

NPI assigned

Nov 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Physician Assistant

Practice roles

Locations

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.

• Tanana Chiefs Conference

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1821201278

  TX

  Medicare reassignment NPD

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248048000000",
    "number": "1184790768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3633",
            "city": "SEWARD",
            "state": "AK",
            "postal_code": "996643633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33280 STONEY CREEK AVE",
            "city": "SEWARD",
            "state": "AK",
            "postal_code": "996643633",
            "telephone_number": "907-224-7094",
            "fax_number": "907-224-7094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TIMOTHY",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "MS PA C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-27",
        "last_updated": "2009-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CL3490",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Denise Gloria Johnson
• Kaleb Johnson
• Mariah Johnson, MSW
• Samuel H Johnson, LCSW
• Simone Johnson
• Chelena Jones, LMSW
• Aaron Julien, PHARMD
• Joseph Kaupu
• Julianna Kaupu
• Jeannia Lynn Keeton

• Physician Assistant in Seward, AK
• Providers in Seward, AK by specialty
• Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2009; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.