Individual provider Active NPI

Elizabeth Johnson

  • Physician Assistant
  • Liverpool, NY
National Provider Identifier
1477956118
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
018172 Issued in NY
Practice address
235 Greenfield Pkwy
Liverpool, NY 13088-6651
Phone
(315) 452-3376
Fax
(315) 452-3377
NPI assigned
Oct 8, 2014
Last updated
May 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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 018172 NY Primary

Addresses

Primary practice location

235 Greenfield Pkwy
Liverpool, NY 13088-6651

Mailing address

PO Box 2003
East Syracuse, NY 13057-4503
Phone (315) 446-3904

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
I20150129000151 NY Practitioner - Physician Assistant 4183948847 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Housel Dermatology PCGroup PAC ID 4789823543, 4 clinicians

Practice addresses (Care Compare)

235 Greenfield Pkwy
Liverpool, NY 13088-6651
Phone (315) 452-3376

Merit-based Incentive Payment System (MIPS)

Final score
97.14 of 100Reported as individual
Quality
94.8
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
018172NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
HCR Manorcare Medical Services of Florida LLC Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1412726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1477956118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2003",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130574503",
            "telephone_number": "315-446-3904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 GREENFIELD PKWY",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130886651",
            "telephone_number": "315-452-3376",
            "fax_number": "315-452-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-08",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liverpool, NY

Sources for this page

Verify at the official NPI Registry.