Active NPI
Shana Johnson, MD
- Physical Medicine & Rehabilitation Physician
- Tumwater, WA
National Provider Identifier
1639373152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- MD 60001063
- Practice address
- 344 Cleveland Ave SE Ste C
Tumwater, WA 98501-3342 - Phone
- (360) 464-7940
- Fax
- (360) 362-8749
- NPI assigned
- Jun 11, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physical Medicine & Rehabilitation Physician | 208100000X | MD 60001063 | WA | Primary |
Addresses
Primary practice location
344 Cleveland Ave SE Ste C
Tumwater, WA 98501-3342
Mailing address
344 Cleveland Ave SE Ste C
Tumwater, WA 98501-3342
Phone (360) 464-7940
Other practice location 1
1959 NE Pacific St
Seattle, WA 98195-0001
Phone (206) 598-3344
Other practice location 2
530 Lilly Rd SE Ste 102
Olympia, WA 98501-2105
Phone (425) 502-5253
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8521783 | Medicaid | WA | |
| BP1-0022479 | Other | INSTITUTIONAL PERMIT | |
| 0241237 | Other | WA | L&I |
| MD 60001063 | Other | WA | MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD 60001063 | WA | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597104000000",
"number": "1639373152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "344 CLEVELAND AVE SE STE C",
"city": "TUMWATER",
"state": "WA",
"postal_code": "985013342",
"telephone_number": "360-464-7940",
"fax_number": "360-362-8749"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "344 CLEVELAND AVE SE STE C",
"city": "TUMWATER",
"state": "WA",
"postal_code": "985013342",
"telephone_number": "360-464-7940",
"fax_number": "360-362-8749"
}
],
"practiceLocations": [
{
"address_1": "1959 NE Pacific St",
"address_purpose": "LOCATION",
"city": "Seattle",
"state": "WA",
"postal_code": "981950001",
"country_code": "US",
"telephone_number": "206-598-3344",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "530 Lilly Rd SE Ste 102",
"address_purpose": "LOCATION",
"city": "Olympia",
"state": "WA",
"postal_code": "985012105",
"country_code": "US",
"telephone_number": "425-502-5253",
"fax_number": "360-362-8749",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JOHNSON",
"first_name": "SHANA",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-11",
"last_updated": "2020-08-11",
"certification_date": "2020-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "WA",
"license": "MD 60001063",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8521783",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INSTITUTIONAL PERMIT",
"identifier": "BP1-0022479",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I",
"identifier": "0241237",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "MD 60001063",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tumwater, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.