Individual provider Active NPI

Amanda Jo Johnson, PA-C

  • Physician Assistant
  • Kalamazoo, MI
National Provider Identifier
1497295984
Registry record updated Mar 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1541 Gull Rd
Suite 200
Kalamazoo, MI 49048-1644
Phone
(269) 552-0331
NPI assigned
Mar 2, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2017

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 MI Primary

Addresses

Primary practice location

1541 Gull Rd
Suite 200
Kalamazoo, MI 49048-1644

Mailing address

8055 Country Pine Dr SE
Alto, MI 49302-9142
Phone (616) 901-0280

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20170518001211 MI Practitioner - Physician Assistant 8022385236 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascension Medical Group PromedGroup PAC ID 7315856077, 255 clinicians

Practice addresses (Care Compare)

1521 Gull Rd
Kalamazoo, MI 49048-1640
Phone (269) 226-5165

1541 Gull Rd
Kalamazoo, MI 49048-1644
Phone (269) 381-7380

7901 Angling Rd
Portage, MI 49024-0714

Hospital & facility affiliations

  • Borgess Medical Center Hospital, Kalamazoo, MI, CCN 230117
  • Three Rivers Health Hospital, Three Rivers, MI, CCN 230015
  • Beacon Plainwell Long-term care hospital, Plainwell, MI, CCN 232034

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Promed Healthcare CurrentSince May 15, 2017 Accepting new patients
Ascension Medical Group Promed CurrentSince May 15, 2017 Accepting new patients
Ascension Medical Group Promed Past Accepting new patients

Locations

551 Linn St
Allegan, MI 49010
Phone (269) 686-5800

3035 Capital Ave SW
Battle Creek, MI 49015
Phone (269) 565-9100

1541 Gull Rd
Ste 200
Kalamazoo, MI 49048
Phone (269) 343-1264

6565 W Main St
Ste 205
Kalamazoo, MI 49009
Phone (269) 226-5456

2520 Robert Jones Way
Kalamazoo, MI 49009
Phone (269) 375-0400

1521 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-5165

215 E Mansion St
Marshall, MI 49068
Phone (269) 789-3940

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

600 S Lakeview Ave
Ste 106
Sturgis, MI 49091
Phone (269) 625-9132

711 S Health Parkway
Three Rivers, MI 49093
Phone (269) 273-9691

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1488412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490832000000",
    "number": "1497295984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8055 COUNTRY PINE DR SE",
            "city": "ALTO",
            "state": "MI",
            "postal_code": "493029142",
            "telephone_number": "616-901-0280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 GULL RD",
            "address_2": "SUITE 200",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481644",
            "telephone_number": "269-552-0331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "AMANDA",
        "middle_name": "JO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-02",
        "last_updated": "2017-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.