Russell P Johnson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA1753 Issued in NV

Practice address

7021 Spring Mountain Rd
Las Vegas, NV 89117-3818

Phone

(702) 803-2222

Fax

(702) 829-7269

NPI assigned

Apr 26, 2006

Last updated

Nov 27, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

Practice roles

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.

• DMC Medical Clinic LTD

  • Primary Care Nurse Practitioner
  • Las Vegas, NV
  • NPI 1699374256
  NPD (past)

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606435200000",
    "number": "1497712483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7021 SPRING MOUNTAIN RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891173818",
            "telephone_number": "702-803-2222",
            "fax_number": "702-829-7269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7021 SPRING MOUNTAIN RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891173818",
            "telephone_number": "702-803-2222",
            "fax_number": "702-829-7269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "RUSSELL",
        "middle_name": "P",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2020-11-27",
        "certification_date": "2020-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "PA",
            "license": "MA003569L",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA003569L",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NV",
            "license": "PA1753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1336749811",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497712483",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "REST",
            "endpointTypeDescription": "RESTful URL",
            "endpoint": "LASVEGAS",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "LASVEGAS",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "LASVEGAS",
            "address_1": "7021 Spring Mountain Rd",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891173818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rosaline Johnson
• Rosemary Johnson
• Rossie Johnson
• Roxie Johnson, CPC INTERN
• Russell Johnson, MD
• Samantha Johnson
• Samona Johnson
• Sarah Johnson
• Sarah Elizabeth Johnson, DC
• Scott J Johnson, LCSW

• Medical Physician Assistant in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Medical Physician Assistant in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.