Susan Mary Hart Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

000687 Issued in CT

Practice address

30 Hyde Ave Ste 109
Vernon, CT 06066-4503

Phone

(860) 454-0303

Fax

(860) 875-4242

NPI assigned

Mar 13, 2007

Last updated

Jun 25, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: susan.johnson@637.emedpractice.direct-ci.com

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.

• Prime Healthcare, PC

  • Internal Medicine Physician
  • Wethersfield, CT
  • NPI 1184819302

  Physician Assistant

  Medicare reassignment NPD

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1497888002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 JORDAN LN",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061091278",
            "telephone_number": "860-263-0253",
            "fax_number": "860-263-0262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 HYDE AVE STE 109",
            "city": "VERNON",
            "state": "CT",
            "postal_code": "060664503",
            "telephone_number": "860-454-0303",
            "fax_number": "860-875-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SUSAN",
        "middle_name": "MARY HART",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-13",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "000687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sjohnson161258@direct.stfranciscare.org",
            "affiliation": "N",
            "endpointDescription": "Prime Healthcare Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "30 Hyde Ave Ste 109",
            "city": "Vernon",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060664503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Patricia L Jacques, OTAL
• Jessica Leila Janton, DMD
• Krithika Jayaprakash, D.D.S.
• Jeffrey a. Burns D.M.D.
• Jennifer Maria Sousa Jerome, APRN
• Carolyn Botti Jones, OTR
• Harold A. Kadish, D.M.D.
• Roopkiranjot Kahlon, M.D.
• Heather Karpey, PPCNP-BC
• Kelly Family Eyecare, LLC

• Physician Assistant in Vernon, CT
• Providers in Vernon, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.