Mathew S Johnson MD PLLC
Organization Active NPI Specialist · Shalimar, FL
NPI 1558055186 · NPPES record last updated Jan 31, 2025
Key facts
- NPI
- 1558055186
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 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
- Organization subpart
- No
Authorized official
- Name
- Matthew Johnson, MD
- Title
- Owner/Provider
- Phone
- (702) 719-9059
Practitioners 5
-
Rachel Ann Houck, ANP, RN
-
Robert Lowry, ARNP
-
Keith A Berens, PAC
-
Jamison Eli Gaddy, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230816003058 | FL | Part B Supplier - Clinic/Group Practice | 5294197653 |
Receives reassigned benefits from 5 practitioners Practice locations: Shalimar, FL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes |
Addresses
Primary practice location
2578 Cayenne LN
Shalimar, FL 32579-1268
Mailing address
2578 Cayenne LN
Shalimar, FL 32579-1268
Phone (520) 409-8320
Other names
- Matthew Johnson MD PLLC
Other providers in Shalimar, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.