Individual provider Active NPI

Carli Marie Johnston, PA-C

  • Physician Assistant
  • New York, NY
National Provider Identifier
1437632247
Registry record updated Mar 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
022694 Issued in NY
Practice address
489 5TH Ave FL 3
New York, NY 10017-6145
Phone
(212) 441-4400
Fax
(415) 252-7176
NPI assigned
Sep 9, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2025

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 022694 NY
Physician Assistant 363A00000X 022694 NY Primary

Addresses

Primary practice location

489 5TH Ave FL 3
New York, NY 10017-6145

Mailing address

129 W 29TH St FL 10
New York, NY 10001-5105
Phone (415) 658-6791

Other practice location 1

201 E 65th St
New York, NY 10065-6701
Phone (814) 558-6914

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20210810003472 NY Practitioner - Physician Assistant 2961806153 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Montefiore Medical CenterGroup PAC ID 3779496021, 2,809 clinicians
One Medical of Ny PCGroup PAC ID 3274713110, 72 clinicians

Practice addresses (Care Compare)

408 W 14TH St
Suite 201
New York, NY 10014-1042
Phone (888) 663-6331

489 5TH Ave
FL 3
New York, NY 10017-6145
Phone (888) 663-6331

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
022694NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Jan 1, 2026 Accepting new patients
One Medical of Ny, P.C. CurrentSince Jan 1, 2026 Accepting new patients
Montefiore Medical Center CurrentSince Jan 1, 2026 Accepting new patients
Mount Sinai School of Medicine Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

408 W 14th St
Ste 201
New York, NY 10014
Phone (212) 530-0639

919 3rd Ave
Ste 105
New York, NY 10022
Phone (212) 530-0650

489 5th Ave
Fl 3
New York, NY 10017
Phone (212) 440-0658

Organizations & group practices 4

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": "1536451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1437632247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 W 29TH ST FL 10",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100015105",
            "telephone_number": "415-658-6791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 5TH AVE FL 3",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100176145",
            "telephone_number": "212-441-4400",
            "fax_number": "415-252-7176"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 E 65th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100656701",
            "country_code": "US",
            "telephone_number": "814-558-6914",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "CARLI",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-09",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "022694",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "022694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.