Individual provider Active NPI

Sheena Marie Johnson, PA

  • Physician Assistant
  • Schenectady, NY
National Provider Identifier
1194951756
Registry record updated Aug 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
013331 Issued in NY
Practice address
1044 State St
Schenectady, NY 12307-1508
Phone
(518) 370-1441
Fax
(183) 959-4315
NPI assigned
Jun 9, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2022

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 013331 NY Primary

Addresses

Primary practice location

1044 State St
Schenectady, NY 12307-1508

Mailing address

3040 Broadway
Schenectady, NY 12306-2102
Phone (518) 357-2011

Other identifiers 1

IdentifierTypeStateIssuer
02995513MedicaidNY

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20090918000177 NY Practitioner - Physician Assistant 7911053855 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Albany Medical College of Union University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Schenectady Family Health Services IncGroup PAC ID 1850280827, 20 clinicians

Practice addresses (Care Compare)

1044 State St
Schenectady, NY 12307-1508
Phone 51837014414155

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
013331NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Schenectady Family Health Services, Inc. CurrentSince Oct 10, 2022 Accepting new patients
Community Care Physicians, PC Past Accepting new patients

Locations

67 Division St
Ste 2
Amsterdam, NY 12010
Phone (518) 627-2110

1044 State St
Schenectady, NY 12307
Phone (518) 370-1441

Organizations & group practices 2

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": "1244505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1194951756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3040 BROADWAY",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123062102",
            "telephone_number": "518-357-2011",
            "fax_number": "518-357-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 STATE ST",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123071508",
            "telephone_number": "518-370-1441",
            "fax_number": "183-959-4315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHEENA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-09",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "013331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02995513",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Schenectady, NY

Sources for this page

Verify at the official NPI Registry.