Individual provider Active NPI

Nancy Moe Johnson, PA

  • Medical Physician Assistant
  • Beloit, WI
National Provider Identifier
1417262528
Registry record updated Nov 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
2640-33 Issued in WI
Practice address
1905 E Huebbe Pkwy
Beloit Clinic
Beloit, WI 53511-1842
Phone
(608) 364-1460
Fax
(608) 363-7317
NPI assigned
Aug 12, 2010
Last updated
Nov 16, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 3203 CO
Medical Physician Assistant 363AM0700X 2640-33 WI Primary

Addresses

Primary practice location

1905 E Huebbe Pkwy
Beloit Clinic
Beloit, WI 53511-1842

Mailing address

1905 E Huebbe Pkwy
Beloit Health System Inc
Beloit, WI 53511-1842
Phone (608) 364-2293

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20110602000463 WI Practitioner - Physician Assistant 0840477709 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health System CorporationGroup PAC ID 7416860440, 749 clinicians

Practice addresses (Care Compare)

1000 Mineral Point Ave
Janesville, WI 53548-2940
Phone (608) 756-6508

2825 Prairie Ave
Beloit, WI 53511-1844
Phone (608) 363-5500

3400 Deerfield Dr
Janesville, WI 53546-3557
Phone (608) 314-3660

N2950 State Rd
Suite 67
Lake Geneva, WI 53147-2655
Phone (608) 756-7100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3203COMDChiropractor
2640-33WIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation Current Accepting new patients
Beloit Clinic, S.C. Current Accepting new patients
Beloit Health System, Inc CurrentSince Oct 17, 2016 Accepting new patients
Mercy Health System Corporation CurrentSince Mar 30, 2020 Accepting new patients
Beloit Health System Inc CurrentSince Oct 17, 2016 Accepting new patients
Southwest Emergency Physicians, PC Past Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

1735 Madison Rd
Beloit, WI 53511
Phone (608) 363-7510

1905 E Huebbe Pkwy
Beloit, WI 53511
Phone (608) 364-2293

1969 W Hart Rd
Beloit, WI 53511
Phone (608) 364-5011

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

N2950 State Road 67
Lake Geneva, WI 53147
Phone (262) 245-0535

Interoperability endpoints

  • Direct secure messaging: njohnson71231@direct.mhemail.org

Organizations & group practices 7

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": "1281571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479254400000",
    "number": "1417262528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 E HUEBBE PKWY",
            "address_2": "BELOIT HEALTH SYSTEM INC",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111842",
            "telephone_number": "608-364-2293",
            "fax_number": "608-364-5452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 E HUEBBE PKWY",
            "address_2": "BELOIT CLINIC",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111842",
            "telephone_number": "608-364-1460",
            "fax_number": "608-363-7317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "NANCY",
        "middle_name": "MOE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-12",
        "last_updated": "2016-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "3203",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "2640-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beloit, WI

Sources for this page

Verify at the official NPI Registry.