Individual provider Active NPI

Daniel P Johnston, MS, PA-C

  • Physician Assistant
  • Wausau, WI
National Provider Identifier
1487885596
Registry record updated Jun 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2462-23 Issued in WI
Practice address
225000 Hummingbird Rd Ste 100
Wausau, WI 54401-2950
Phone
(715) 359-6442
Fax
(715) 393-0390
NPI assigned
Aug 6, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2021

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 2462-23 WI Primary

Addresses

Primary practice location

225000 Hummingbird Rd Ste 100
Wausau, WI 54401-2950

Mailing address

225000 Hummingbird Rd Ste 100
Wausau, WI 54401-2950
Phone (715) 359-6442

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20090903000687 WI Practitioner - Physician Assistant 1254486780

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

225000 Hummingbird Rd
Suite 100
Wausau, WI 54401-2948

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

NPI Registry JSON

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

{
    "created_epoch": "1249516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623888000000",
    "number": "1487885596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225000 HUMMINGBIRD RD STE 100",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544012950",
            "telephone_number": "715-359-6442",
            "fax_number": "715-393-0390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225000 HUMMINGBIRD RD STE 100",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544012950",
            "telephone_number": "715-359-6442",
            "fax_number": "715-393-0390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "DANIEL",
        "middle_name": "P",
        "credential": "MS, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-06",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2462-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

Verify at the official NPI Registry.