Individual provider Active NPI

Shelby Field Johnson, PA-C

  • Physician Assistant
  • Orlando, FL
National Provider Identifier
1356883532
Registry record updated Oct 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9111213 Issued in FL
Practice address
601 E Rollins St
Orlando, FL 32803-1248
Phone
(407) 303-7283
Fax
(407) 303-0347
NPI assigned
Nov 5, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA058733 PA
Physician Assistant 363A00000X PA9111213 FL Primary
Physician Assistant 363A00000X OA003978 PA

Addresses

Primary practice location

601 E Rollins St
Orlando, FL 32803-1248

Mailing address

601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 303-7283

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20190109001107 FL Practitioner - Physician Assistant 4183907439 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Practice addresses (Care Compare)

2600 Westhall LN
Maitland, FL 32751-7102
Phone (407) 200-2700

601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 303-2570

Hospital & facility affiliations

  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
OA003978PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Physician Assistant CurrentSince Oct 15, 2018 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Oct 15, 2018 Accepting new patients

Locations

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

601 E Rollins St
Orlando, FL 32803
Phone (407) 303-1996

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: sjohnson129236@adventhealth.direct-ci.com

Organizations & group practices 2

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": "1478304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1356883532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E ROLLINS ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031248",
            "telephone_number": "407-303-7283",
            "fax_number": "407-303-0347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E ROLLINS ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031248",
            "telephone_number": "407-303-7283",
            "fax_number": "407-303-0347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHELBY",
        "middle_name": "FIELD",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-05",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA058733",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9111213",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "OA003978",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.