Shantae Monae Johnson, AGACNP-BC

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

4704245204 Issued in MI

Practice address

100 Mack Ave FL 1
Detroit, MI 48201-2416

Phone

(313) 818-8207

NPI assigned

Sep 28, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

City of DetroitGroup PAC ID 1456312388, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• City of Detroit

  • Public Health or Welfare Agency
  • Detroit, MI
  • NPI 1033429394
  Medicare reassignment Care Compare group NPD
• Pioneer Medical Group PLLC

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1801304688
  Medicare reassignment NPD
• Vpa PC

  • Family Medicine Physician
  • Portage, MI
  • NPI 1669091864
  Medicare reassignment NPD
• Vpa PC

  • Family Medicine Physician
  • Troy, MI
  • NPI 1336153295
  NPD
• Vpa PC

  • Family Medicine Physician
  • Brentwood, TN
  • NPI 1578363362
  NPD
• City of Detroit

  • Community/Behavioral Health Agency
  • Detroit, MI
  • NPI 1740402114
  NPD (past)

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

{
    "created_epoch": "1475020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753747200000",
    "number": "1417406752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11331 HAZELTON",
            "city": "REDFORD",
            "state": "MI",
            "postal_code": "482391429",
            "telephone_number": "313-231-6110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MACK AVE FL 1",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012416",
            "telephone_number": "313-818-8207"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6071 W Outer Dr",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482352624",
            "country_code": "US",
            "telephone_number": "313-966-6075",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHANTAE",
        "middle_name": "MONAE",
        "name_prefix": "Mrs.",
        "credential": "AGACNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-28",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704245204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samara Johnson
• Sandra Johnson
• Serena A Johnson, LLMSW
• Shanae Johnson
• Shanonielle Johnson, RN
• Shara L. Johnson, PH.D.
• Sharniece Alexis Johnson
• Sharon Denise Johnson, M.A., LPC
• Shauntez Antoine Johnson, LLMSW
• Shelly Lynn Johnson

• Acute Care Nurse Practitioner in Detroit, MI
• Providers in Detroit, MI by specialty
• Acute Care Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.