Mathew S Johnson MD PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

MATHEW S JOHNSON MD PLLC

Practice address

2578 Cayenne LN
Shalimar, FL 32579-1268

Phone

(520) 409-8320

NPI assigned

Jun 6, 2023

Last updated

Jan 31, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Matthew Johnson, MDNPI 1770607871

Title

Owner/Provider

Phone

(702) 719-9059

Specialties & licenses 1

Addresses

Other names 1

• Matthew Johnson MD PLLC Other name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew S Johnson, MD

  • Surgery Physician
  • Fort Walton Beach, FL
  • NPI 1770607871
  Medicare reassignment NPD Authorized official
• Rachel Ann Houck, ANP, RN

  • Family Nurse Practitioner
  • Fort Walton Beach, FL
  • NPI 1669954152
  Medicare reassignment NPD
• Robert Lowry, ARNP

  • Family Nurse Practitioner
  • Defuniak Springs, FL
  • NPI 1982135893
  Medicare reassignment NPD
• Keith A Berens, PAC

  • Physician Assistant
  • Pensacola, FL
  • NPI 1174505788
  Medicare reassignment
• Jamison Eli Gaddy, PA-C

  • Physician Assistant
  • Fort Hood, TX
  • NPI 1528236809

  FL

  Medicare reassignment

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

{
    "created_epoch": "1686009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738281600000",
    "number": "1558055186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2578 CAYENNE LN",
            "city": "SHALIMAR",
            "state": "FL",
            "postal_code": "325791268",
            "telephone_number": "520-409-8320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2578 CAYENNE LN",
            "city": "SHALIMAR",
            "state": "FL",
            "postal_code": "325791268",
            "telephone_number": "520-409-8320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATHEW S JOHNSON MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-06",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "702-719-9059",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Matthew Johnson MD PLLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Amanda Liles, APRN
• Hannah Elizabeth Lillis
• Brittani Lutz-Midthun
• Hannah Maksimovic
• Lorena Davis Manning, LMHC
• Marisa McCormack
• Randi Nichols McDonald, PSY.D.
• Tracey Lynn McDonough, LPN
• Megan McGoldrick
• Ariya F McGrory, LCSW

• Specialist in Shalimar, FL
• Providers in Shalimar, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.