NPIMap

Individual provider Active NPI

Jennifer Johnson, PA-C

  • Physician Assistant
  • Rapid City, SD
National Provider Identifier
1194763995
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0510 Issued in SD
Practice address
101 E Minnesota St
Rapid City, SD 57701-7756
Phone
(605) 342-3280
NPI assigned
Jun 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0510 SD Primary

Addresses

Primary practice location

101 E Minnesota St
Rapid City, SD 57701-7756

Mailing address

2820 Mount Rushmore Rd
Rapid City, SD 57701-5462

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100329001177 SD Practitioner - Physician Assistant 1153457148

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2820 Mount Rushmore Rd
Rapid City, SD 57701-5462

Hospital & facility affiliations

  • Monument Health Home Plus Home Health Home health agency, Rapid City, SD, CCN 437003
  • Monument Health Rapid City Hospital Hospital, Rapid City, SD, CCN 430077
  • Black Hills Surgical Hospital LLC Hospital, Rapid City, SD, CCN 430091

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Interoperability endpoints

  • Direct secure messaging: jennifer.johnson@rcmc.eclinicaldirectplus.com

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1194763995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 MOUNT RUSHMORE RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577015462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E MINNESOTA ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017756",
            "telephone_number": "605-342-3280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JENNIFER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-03",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

Verify at the official NPI Registry.