Lisa Marie Johnson, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9108416 Issued in FL

Practice address

150 5TH Ave Ste a
Indialantic, FL 32903-3154

Phone

(321) 254-6803

Fax

(321) 254-6819

NPI assigned

Feb 13, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2025 through Jan 1, 2027

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lisa.johnson@379449806487556.direct.elationemr.com

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.

• RHMD LLC

  • Family Medicine Physician
  • Indialantic, FL
  • NPI 1689928590
  NPD
• Integris Ambulatory Care C Orporation

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1326076027
  NPD (past)
• NRHS West Family Medicine Associates

  • Family Medicine Physician
  • Norman, OK
  • NPI 1497035117
  NPD (past)
• Oca 1 LLC

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1558373076
  NPD (past)
• Oca MWC LP

  • Family Medicine Physician
  • Midwest City, OK
  • NPI 1417105321
  NPD (past)
• Oca Norman, LP

  • Family Medicine Physician
  • Norman, OK
  • NPI 1083626253
  NPD (past)
• Quick Clinic LLC

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1356412225
  NPD (past)

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648425600000",
    "number": "1295877785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 5TH AVE STE A",
            "city": "INDIALANTIC",
            "state": "FL",
            "postal_code": "329033154",
            "telephone_number": "321-254-6803",
            "fax_number": "321-254-6819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 5TH AVE STE A",
            "city": "INDIALANTIC",
            "state": "FL",
            "postal_code": "329033154",
            "telephone_number": "321-254-6803",
            "fax_number": "321-254-6819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-13",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "1338",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9108416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200028010A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Indialantic Medical Associates, LLC
• Indialantic Psychiatry & Counseling Center, Inc.
• Jay Medical PLLC
• Jessica L. Mansfield, DDS, PA
• Hannah Naomi Johnson
• Joseph Rabinowitz MD PA
• Keesey Company
• Barbara Elaine Kennedy, LNHC
• Carmarie Kharazi
• Candice Klein, CANDICE KLEIN

• Medical Physician Assistant in Indialantic, FL
• Providers in Indialantic, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.