Active NPI
Julie Jackson Johnson, PA-C
- Physician Assistant
- Colorado Springs, CO
National Provider Identifier
1417112343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2615
- Practice address
- 2130 Hollow Brook Dr
Suite #100
Colorado Springs, CO 80918-8400 - Phone
- (719) 590-7007
- Fax
- (719) 590-7037
- NPI assigned
- Jul 21, 2008
- Sex
- Female
- 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 | 2615 | CO | Primary |
Addresses
Primary practice location
2130 Hollow Brook Dr
Suite #100
Colorado Springs, CO 80918-8400
Mailing address
175 S Union Blvd
Ste 350
Colorado Springs, CO 80910-3146
Phone (719) 590-7007
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231106003304 | FL | Order and Referring Only - Physician Assistant | 5496920928 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2615 | CO | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486598400000",
"number": "1417112343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 S UNION BLVD",
"address_2": "STE 350",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809103146",
"telephone_number": "719-590-7007",
"fax_number": "719-590-7037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2130 HOLLOW BROOK DR",
"address_2": "SUITE #100",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809188400",
"telephone_number": "719-590-7007",
"fax_number": "719-590-7037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JULIE",
"middle_name": "JACKSON",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-21",
"last_updated": "2017-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "2615",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2017; 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.