Individual provider Active NPI

Brett Johnson, PA-C

  • Physician Assistant
  • Fort Pierce, FL
National Provider Identifier
1386340214
Registry record updated Feb 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9116992 Issued in FL
Practice address
2401 Frist Blvd Ste 4
Fort Pierce, FL 34950-4800
Phone
(772) 595-5302
Fax
(772) 595-5304
NPI assigned
Feb 2, 2023
Last updated
Feb 2, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9116992 FL Primary

Addresses

Primary practice location

2401 Frist Blvd Ste 4
Fort Pierce, FL 34950-4800

Mailing address

10463 Hunters Haven Blvd
Riverview, FL 33578-3363

Other identifiers 1

IdentifierTypeStateIssuer
1922275866MedicaidFL

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
I20230601001133 FL Practitioner - Physician Assistant 5294192522 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Palm Beach General Surgery LLCGroup PAC ID 1456455021, 69 clinicians

Practice addresses (Care Compare)

1700 S 23Rd St
Fort Pierce, FL 34950-4803
Phone (772) 462-4100

1800 SE Tiffany Ave
St Lucie Medical Center
Port Saint Lucie, FL 34952-7521
Phone (772) 335-4000

1825 SE Tiffany Ave
Port Saint Lucie, FL 34952-7554
Phone (772) 335-4000

1943 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5535
Phone (772) 595-5302

2401 Frist Blvd
Fort Pierce, FL 34950-4800
Phone (772) 595-5302

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9116992FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Palm Beach General Surgery LLC CurrentSince May 1, 2023 Accepting new patients

Locations

2401 Frist Blvd
Ste 4
Fort Pierce, FL 34950
Phone (772) 466-1567

1825 SE Tiffany Ave
Ste 101
Port St Lucie, FL 34952
Phone (772) 219-4026

1943 SE Port St Lucie Blvd
Port St Lucie, FL 34952
Phone (772) 335-3400

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 1

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.

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": "1675296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1386340214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10463 HUNTERS HAVEN BLVD",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335783363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 FRIST BLVD STE 4",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349504800",
            "telephone_number": "772-595-5302",
            "fax_number": "772-595-5304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BRETT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-02-02",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9116992",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922275866",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Pierce, FL

Sources for this page

Verify at the official NPI Registry.