NPIMap

Individual provider Active NPI

Robert Johansen, PA-C

  • Physician Assistant
  • Omak, WA
National Provider Identifier
1639452618
Registry record updated Sep 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60248541 Issued in WA
Practice address
529 Jasmine St
Omak, WA 98841-9589
Phone
(509) 826-1600
NPI assigned
Sep 26, 2011
Last updated
Sep 10, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2015

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 PA60248541 WA Primary
Medical Physician Assistant 363AM0700X PA60248541 WA

Addresses

Primary practice location

529 Jasmine St
Omak, WA 98841-9589

Mailing address

529 Jasmine St
Omak, WA 98841-9589
Phone (509) 826-1600

Other identifiers 1

IdentifierTypeStateIssuer
1639452618MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111010000467 WA Practitioner - Physician Assistant 3274705561 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Yakima Valley Memorial PhysiciansGroup PAC ID 1557391596, 397 clinicians

Practice addresses (Care Compare)

2811 Tieton Dr
Yakima, WA 98902-3761
Phone (509) 575-8000

406 S 30TH Ave
Yakima, WA 98902-3713

579 E Main St
Elma, WA 98541-9551
Phone (360) 346-2222

600 E Main St
Elma, WA 98541-9560
Phone (360) 346-2222

610 E Main St
Elma, WA 98541-9353
Phone (360) 346-2222

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Grays Harbor County Public Hospital District No 1 CurrentSince Nov 1, 2024 Accepting new patients
Yakima Valley Memorial Physicians CurrentSince Sep 26, 2023 Accepting new patients
Yakima Valley Memorial Physicians CurrentSince Sep 26, 2023 Accepting new patients
Grays Harbor County Public Hospital District No. 1 CurrentSince Nov 1, 2024 Accepting new patients
Okanogan County Public Hospital Dist No 4 CurrentSince Oct 9, 2019 Accepting new patients

Locations

600 E Main St
Elma, WA 98541
Phone (360) 346-2222

203 S Western Ave
Tonasket, WA 98855
Phone (509) 486-2151

2811 Tieton Dr
Yakima, WA 98902
Phone (509) 249-5210

Interoperability endpoints

  • Direct secure messaging: johansenr@mvhealth.cernerdirect.com

Organizations & group practices 7

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.

Hospital & facility affiliations 3

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": "1316995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441843200000",
    "number": "1639452618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 JASMINE ST",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "988419589",
            "telephone_number": "509-826-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 JASMINE ST",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "988419589",
            "telephone_number": "509-826-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSEN",
        "first_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-26",
        "last_updated": "2015-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60248541",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60248541",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639452618",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omak, WA

Sources for this page

Verify at the official NPI Registry.