Active NPI
Elyssa Marie Johnson, PA-C
- Physician Assistant
- Frackville, PA
National Provider Identifier
1477804417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- MA055747
- Practice address
- 701 W Oak St
Frackville, PA 17931-1672 - Phone
- (570) 874-4100
- NPI assigned
- Oct 1, 2012
- Last updated
- Aug 17, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA055747 | PA | Primary |
Addresses
Primary practice location
701 W Oak St
Frackville, PA 17931-1672
Mailing address
100 N Academy Ave
Credential Dept
Danville, PA 17822-4903
Phone (570) 271-6144
Other names 1
- Ms. Elyssa Marie Nieddu
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | enieddu105193@direct.geisinger.edu | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Phoenix Rehabilitation and Health Services Inc
Practice addresses (Care Compare)
100 N Academy Ave
Danville, PA 17822-9800
Phone (570) 271-6144
2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238
31 S Main St
Mahanoy City, PA 17948-2647
Phone (570) 773-3042
701 W Oak St
Fracksville, PA 17931-1672
Phone (570) 874-4100
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Geisinger Clinic | Current | Accepting new patients | |
| Geisinger Clinic | Current | Accepting new patients | |
| Geisinger Clinic | Physician Assistant | Past | Accepting new patients |
| Geisinger Clinic | Past | Accepting new patients |
Locations
100 N Academy Ave
Danville, PA 17822
701 W Oak St
Frackville, PA 17931
Phone (570) 874-4100
316 Mauch Chunk St
#577885
Pottsville, PA 17901
Phone (570) 622-2291
Interoperability endpoints
- enieddu105193@direct.geisinger.edu
Organizations & group practices 5
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.
-
- Family Medicine Physician
- Danville, PA
- NPI 1366493868
-
- Diagnostic Radiology Physician
- Danville, PA
- NPI 1558313023
-
- Family Medicine Physician
- Mifflintown, PA
- NPI 1558897868
-
- Surgery Physician
- Danville, PA
- NPI 1255382784
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Hazleton, PA
- NPI 1386641330
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597622400000",
"number": "1477804417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 N ACADEMY AVE",
"address_2": "CREDENTIAL DEPT",
"city": "DANVILLE",
"state": "PA",
"postal_code": "178224903",
"telephone_number": "570-271-6144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 W OAK ST",
"city": "FRACKVILLE",
"state": "PA",
"postal_code": "179311672",
"telephone_number": "570-874-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "ELYSSA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-01",
"last_updated": "2020-08-17",
"certification_date": "2020-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA055747",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "enieddu105193@direct.geisinger.edu",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "701 W Oak St",
"city": "Frackville",
"state": "PA",
"country_code": "US",
"postal_code": "179311672",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "ELYSSA",
"last_name": "NIEDDU",
"middle_name": "MARIE",
"prefix": "MS.",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Frackville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2020; 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.