Individual provider Active NPI

Sue Ann Johnson, FNP

  • Primary Care Nurse Practitioner
  • San Tan Valley, AZ
National Provider Identifier
1356030902
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
288408 Issued in AZ
Practice address
37100 N Gantzel Rd Ste 201
San Tan Valley, AZ 85140-7352
Phone
(480) 394-4469
NPI assigned
May 1, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 288408 AZ Primary

Addresses

Primary practice location

37100 N Gantzel Rd Ste 201
San Tan Valley, AZ 85140-7352

Mailing address

5698 W Sand CT
San Tan Valley, AZ 85142-3166
Phone (520) 509-5544

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
I20230714002241 AZ Practitioner - Nurse Practitioner 2668832221 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Banner Primary Care Physicians Arizona LLCGroup PAC ID 6406020155, 236 clinicians

Practice addresses (Care Compare)

37100 N Gantzel Rd
Suite 201
San Tan Valley, AZ 85140-7352
Phone (480) 394-4469

Hospital & facility affiliations

  • Banner Home Care-Arizona Home health agency, Mesa, AZ, CCN 037015
  • Banner Ironwood Medical Center Hospital, Queen Creek, AZ, CCN 030130

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Primary Care Physicians Arizona LLC CurrentSince Jul 1, 2023 Accepting new patients
Banner Primary Care Physicians Arizona LLC CurrentSince Jul 1, 2023 Accepting new patients
Banner Primary Care Physicians Arizona LLC Past Accepting new patients

Locations

17900 N Porter Rd
Maricopa, AZ 85138
Phone (520) 233-2500

13640 N Plaza del Rio Blvd
Peoria, AZ 85381
Phone (623) 876-3800

1441 N 12th St
Phoenix, AZ 85006
Phone (602) 495-4577

37100 N Gantzel Rd
Ste 201
San Tan Vly, AZ 85140
Phone (480) 394-4469

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1682899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1356030902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5698 W SAND CT",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851423166",
            "telephone_number": "520-509-5544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37100 N GANTZEL RD STE 201",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851407352",
            "telephone_number": "480-394-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SUE",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-01",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AZ",
            "license": "288408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Tan Valley, AZ

Sources for this page

Verify at the official NPI Registry.