Active NPI
Jeffery L Johnson, PA
- Physician Assistant
- Eagle, ID
National Provider Identifier
1609887801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA416
- Practice address
- 3217 W Bavaria Street
Eagle, ID 83616 - Phone
- (208) 239-1000
- Fax
- (208) 239-2136
- NPI assigned
- Aug 11, 2006
- Last updated
- Feb 3, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA416 | ID | Primary |
Addresses
Primary practice location
3217 W Bavaria Street
Eagle, ID 83616
Mailing address
3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 286-6676
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
5985 W State St
Boise, ID 83703-3039
Phone (208) 853-0071
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA416 | ID | MD | Physician Assistant |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612310400000",
"number": "1609887801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3340 E GOLDSTONE WAY",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836421026",
"telephone_number": "208-286-6676",
"fax_number": "208-947-3419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3217 W BAVARIA STREET",
"city": "EAGLE",
"state": "ID",
"postal_code": "83616",
"telephone_number": "208-239-1000",
"fax_number": "208-239-2136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JEFFERY",
"middle_name": "L",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-11",
"last_updated": "2021-02-03",
"certification_date": "2021-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ID",
"license": "PA416",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.