Active NPI
Scott Roger Johnson, PA-C
- Physician Assistant
- La Pine, OR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 00826
- Practice address
- 51600 Huntington Rd
La Pine, OR 97739-8887 - Phone
- (541) 536-3435
- NPI assigned
- Jan 15, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 00826 | OR | Primary |
Addresses
Primary practice location
51600 Huntington Rd
La Pine, OR 97739-8887
Mailing address
PO Box 3300
La Pine, OR 97739-3300
Phone (541) 536-3435
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00826 | OR | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Icco LLC | Current | Accepting new patients | |
| Samaritan Pacific Health Services Inc | Current | Accepting new patients | |
| Samaritan Pacific Health Services, Inc | Current | Accepting new patients | |
| Icco, LLC | Current | Accepting new patients | |
| Icco, LLC | Past | Accepting new patients |
Locations
108 NW Sisemore St
Ste 120
Bend, OR 97703
Phone (541) 213-2133
598 E 13th Ave
Eugene, OR 97401
Phone (541) 636-3473
930 SW Abbey St
Newport, OR 97365
Phone (541) 265-2244
930 SW Abbey St
Ste F
Newport, OR 97365
Phone (541) 574-4860
Organizations & group practices 7
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Urgent Care Clinic/Center
- Dallas, OR
- NPI 1265871123
-
dba Samaritan Medical Group Occupational Medicine - Newport
- Physical Medicine & Rehabilitation Physician
- Newport, OR
- NPI 1174888010
-
dba Samaritan Infectious Disease - Newport
- Infectious Disease Physician
- Newport, OR
- NPI 1881282721
-
dba Samaritan Kidney Specialists - Newport
- Rural Health Clinic/Center
- Depoe Bay, OR
- NPI 1164781142
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200355200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662595200000",
"number": "1275719650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3300",
"city": "LA PINE",
"state": "OR",
"postal_code": "977393300",
"telephone_number": "541-536-3435",
"fax_number": "541-536-8047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51600 HUNTINGTON RD",
"city": "LA PINE",
"state": "OR",
"postal_code": "977398887",
"telephone_number": "541-536-3435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "SCOTT",
"middle_name": "ROGER",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-01-15",
"last_updated": "2022-09-08",
"certification_date": "2022-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "00826",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Pine, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.