Active NPI
Gary Lynn Johnson, PA
- Physician Assistant
- South Charleston, WV
National Provider Identifier
1336116003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 01092
- Practice address
- 610 Chestnut St
South Charleston, WV 25309-1251 - Phone
- (304) 766-7515
- Fax
- (304) 766-7566
- NPI assigned
- Mar 2, 2006
- 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 | 01092 | WV | Primary |
Addresses
Primary practice location
610 Chestnut St
South Charleston, WV 25309-1251
Mailing address
107 Rocky Step Rd
Scott Depot, WV 25560-9631
Phone (304) 412-4243
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1071247 | Other | WV | WV DWC |
| 01092 | Other | WV | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- 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 |
|---|---|---|---|
| 01092 | WV | MD | Physician Assistant |
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.
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- Emergency Medicine Physician
- Huntington, WV
- NPI 1487109104
-
- Emergency Medicine Physician
- Gassaway, WV
- NPI 1568401461
-
- Emergency Medicine Physician
- Huntington, WV
- NPI 1588196851
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197849600000",
"number": "1336116003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 ROCKY STEP RD",
"city": "SCOTT DEPOT",
"state": "WV",
"postal_code": "255609631",
"telephone_number": "304-412-4243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 CHESTNUT ST",
"city": "SOUTH CHARLESTON",
"state": "WV",
"postal_code": "253091251",
"telephone_number": "304-766-7515",
"fax_number": "304-766-7566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "GARY",
"middle_name": "LYNN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-02",
"last_updated": "2007-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WV",
"license": "01092",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WV DWC",
"identifier": "1071247",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "01092",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; 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.