NPIMap

Individual provider Active NPI

Justin Michael Johnson, PA-C

  • Physician Assistant
  • Boise, ID
National Provider Identifier
1619362480
Registry record updated Aug 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-2296 Issued in ID
Practice address
1075 N Curtis Rd Ste 300
Boise, ID 83706-1348
Phone
(208) 302-3100
Fax
(208) 302-3155
NPI assigned
Mar 30, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10816599-1206 UT
Physician Assistant 363A00000X PA-2296 ID Primary

Addresses

Primary practice location

1075 N Curtis Rd Ste 300
Boise, ID 83706-1348

Mailing address

3340 E Goldstone Dr
Meridian, ID 83642-1026
Phone (208) 367-5170

Other practice location 1

3895 Harrison Blvd
Ogden, UT 84403-2312
Phone (801) 387-7678

Other identifiers 1

IdentifierTypeStateIssuer
1619362480MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150622002778 NV Practitioner - Physician Assistant 2769793462 Reassigns benefits to 1 organization
I20220909002140 ID Practitioner - Physician Assistant 2769793462 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1055 N Curtis
Boise, ID 83706-1309

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

1075 N Curtis Rd
Boise, ID 83706-1348

3025 W Cherry LN
Meridian, ID 83642-8531

4424 E Flamingo Ave
Nampa, ID 83687-9291
Phone (208) 302-3200

712 Aviation Way
Caldwell, ID 83605-1154
Phone (208) 302-1035

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-2296IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc Physician Assistant CurrentSince Oct 1, 2022 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Oct 1, 2022 Accepting new patients

Locations

1075 N Curtis Rd
Ste 300
Boise, ID 83706
Phone (208) 323-2600

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

712 Aviation Way
Caldwell, ID 83605
Phone (208) 302-7100

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

4424 E Flamingo Ave
Ste 110
Nampa, ID 83687
Phone (208) 288-4700

Interoperability endpoints

  • Direct secure messaging: jjohnson2124069@direct.trinity-health.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1427673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1619362480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-367-5170",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 N CURTIS RD STE 300",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061348",
            "telephone_number": "208-302-3100",
            "fax_number": "208-302-3155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3895 Harrison Blvd",
            "address_purpose": "LOCATION",
            "city": "Ogden",
            "state": "UT",
            "postal_code": "844032312",
            "country_code": "US",
            "telephone_number": "801-387-7678",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JUSTIN",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-30",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "10816599-1206",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619362480",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.