Marc A Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1915 Issued in CO

Practice address

545 3Rd St Unit 308
Monument, CO 80132-4513

Phone

(719) 733-3086

NPI assigned

Jun 15, 2006

Sex

Male

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 1

Medicare fee-for-service enrollment

Enrolled in CO

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

Physician Assistant

State licenses

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.

• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1225356868
  Medicare reassignment NPD
• 1St Choice Surgical Services Inc

  • Physician Assistant
  • Colorado Springs, CO
  • NPI 1376581793
  NPD Authorized official
• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1366763260
  NPD
• Colorado Springs Urological Associates LLC

  • Urology Physician
  • Colorado Springs, CO
  • NPI 1649704826
  NPD (past)

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1194769612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 673",
            "city": "MONUMENT",
            "state": "CO",
            "postal_code": "801320673",
            "telephone_number": "719-650-7994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 3RD ST UNIT 308",
            "city": "MONUMENT",
            "state": "CO",
            "postal_code": "801324513",
            "telephone_number": "719-733-3086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARC",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2022-02-03",
        "certification_date": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "1915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19130538",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• JD Glover, PLLC
• Jeffrey Yelle PLLC
• Michele Jezek
• Ashley Brooke Johnson, DO
• Lori K Johnson, NP
• Raekwon Domanic Johnson
• Ryan Douglas Johnson, M.D.
• Amber Johnston
• Jonathan C. Chang, M.D.
• David J. Jones, DDS

• Physician Assistant in Monument, CO
• Providers in Monument, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; 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.