NPIMap

Individual provider Active NPI

Mollie K Johnson, PA

  • Physician Assistant
  • Wilmington, NC
National Provider Identifier
1457336240
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
102166 Issued in NC
Practice address
1025 Medical Center Dr
Wilmington, NC 28401
Phone
(910) 341-1886
Fax
(910) 343-6019
NPI assigned
Dec 14, 2005
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 102166 NC Primary

Addresses

Primary practice location

1025 Medical Center Dr
Wilmington, NC 28401

Mailing address

1025 Medical Center Dr
Wilmington, NC 28401
Phone (910) 343-4934

Other identifiers 3

IdentifierTypeStateIssuer
8901898MedicaidNC
0001-02166OtherNCMEDICAL LICENSE
7901897MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111103000024 NC Practitioner - Physician Assistant 3375716517 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Delaney Radiologists Group PLLCGroup PAC ID 4981684875, 55 clinicians
Delaney Radiologists PAGroup PAC ID 6305813684, 55 clinicians

Practice addresses (Care Compare)

1025 Medical Ctr Dr
Wilmington, NC 28401-7354
Phone (910) 762-3882

2131 S 17TH St
Wilmington, NC 28401-7407
Phone (910) 343-7000

5301 Wrightsville Ave
Wilmington, NC 28403-6510
Phone (910) 452-8100

924 N Howe St
Southport, NC 28461-3038
Phone (910) 763-1800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.57 of 100Reported as group
Quality
80.67
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
81.72 of 100Reported as group
Quality
88.57
Improvement activities
40
Cost
60.01

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Rehabilitation Associates PastSince Jul 8, 1996 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mjohnson411563@direct.novanthealth.org

Organizations & group practices 3

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 8

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": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1457336240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "28401",
            "telephone_number": "910-343-4934",
            "fax_number": "910-343-6019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "28401",
            "telephone_number": "910-341-1886",
            "fax_number": "910-343-6019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MOLLIE",
        "middle_name": "K",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-14",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "102166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8901898",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "0001-02166",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7901897",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.