Individual provider Active NPI

Johnnie Roger Lewis Jr., FNP-C

  • Family Nurse Practitioner
  • Tucson, AZ
National Provider Identifier
1255879185
Registry record updated Feb 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP9910 Issued in AZ
Practice address
839 W Congress St
Tucson, AZ 85745-2819
Phone
(520) 670-3909
Fax
(520) 309-2560
NPI assigned
Feb 12, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN160482 AZ
Family Nurse Practitioner 363LF0000X AP9910 AZ Primary

Addresses

Primary practice location

839 W Congress St
Tucson, AZ 85745-2819

Mailing address

839 W Congress St
Tucson, AZ 85745-2819
Phone (520) 670-3909

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20170816003771 AZ Practitioner - Nurse Practitioner 9830461441 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

320 W Prince Rd
Tucson, AZ 85705-3526
Phone (520) 670-3909

6950 E Golf Links Rd
Tucson, AZ 85730-1017
Phone (520) 670-3909

839 W Congress St
Tucson, AZ 85745-2819
Phone (520) 670-3909

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP9910AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
El Rio Santa Cruz Neighborhood Health Center, Inc CurrentSince Aug 1, 2017 Accepting new patients
El Rio Santa Cruz Neighborhood Health Center, Inc CurrentSince Aug 1, 2017 Accepting new patients
El Rio Santa Cruz Neighborhood Health Center, Inc Past Accepting new patients

Locations

101 W Irvington Rd
Tucson, AZ 85714
Phone (520) 573-0096

5979 E Grant Rd
Ste 107
Tucson, AZ 85712
Phone (520) 535-2588

320 W Prince Rd
Tucson, AZ 85705
Phone (520) 838-7663

630 N Alvernon Way
Tucson, AZ 85711
Phone (520) 202-1800

1500 W Commerce Ct
Bldg 12
Tucson, AZ 85746

839 W Congress St
Tucson, AZ 85745
Phone (520) 670-3707

1101 E Broadway Blvd
Tucson, AZ 85719
Phone (520) 624-7750

Interoperability endpoints

  • Direct secure messaging: jlewis18228@elrio.direct.ci.com

Organizations & group practices 3

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": "1486857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739318400000",
    "number": "1255879185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "839 W CONGRESS ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857452819",
            "telephone_number": "520-670-3909",
            "fax_number": "520-309-2560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "839 W CONGRESS ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857452819",
            "telephone_number": "520-670-3909",
            "fax_number": "520-309-2560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "JOHNNIE",
        "middle_name": "ROGER",
        "name_suffix": "Jr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-12",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN160482",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP9910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.