Individual provider Active NPI

Brandon Lee Johnson, FNP-C

  • Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1417358482
Registry record updated Jul 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71018116A Issued in IN
Practice address
1818 Carew St Ste 120
Fort Wayne, IN 46805-4764
Phone
(260) 425-6200
Fax
(260) 425-6205
NPI assigned
Sep 10, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71018116A IN Primary

Addresses

Primary practice location

1818 Carew St Ste 120
Fort Wayne, IN 46805-4764

Mailing address

341 Ponce de Leon Ave NE
Atlanta, GA 30308-2012
Phone (260) 615-7118

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20260612003498 IN Practitioner - Nurse Practitioner 9032438734 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11109 Parkview Plaza Dr
Suite 117
Fort Wayne, IN 46845-1701

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN226151GAMDFamily Nurse Practitioner

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1410307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784851200000",
    "number": "1417358482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "341 PONCE DE LEON AVE NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082012",
            "telephone_number": "260-615-7118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 CAREW ST STE 120",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054764",
            "telephone_number": "260-425-6200",
            "fax_number": "260-425-6205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BRANDON",
        "middle_name": "LEE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-10",
        "last_updated": "2026-07-24",
        "certification_date": "2026-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71018116A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.