Blake Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

804 22ND Ave
Kearney, NE 68845-2206

Phone

(308) 455-3600

NPI assigned

Jan 16, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bryan Hospital KearneyGroup PAC ID 5991195547, 116 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bjohnson175092@hisp.bryanhealth.org

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.

• Bryan Hospital Kearney

  • Family Medicine Physician
  • Kearney, NE
  • NPI 1033875380
  Medicare reassignment Care Compare group
• Bryan Hospital Kearney

  • General Acute Care Hospital
  • Kearney, NE
  • NPI 1407513484
  NPD

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

{
    "created_epoch": "1516060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516060800000",
    "number": "1659889368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 22ND AVE",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688452206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 22ND AVE",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688452206",
            "telephone_number": "308-455-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BLAKE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-16",
        "last_updated": "2018-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kwang Hee Alexander Johng, CRNA
• Andrea Christine Johnson, PA-C
• Ann Elizabeth Johnson, APRN
• Ashlyn Johnson
• Betty Louann Johnson, MA
• Kaleigh Anne Johnson, RN
• Kit Johnson, LADC, CDGC, LIMHP
• Kyler Michelle Johnson, PHYSICIAN ASSISTANT
• Lynette Johnson
• Mandy Jane Johnson, OD

• Physician Assistant in Kearney, NE
• Providers in Kearney, NE by specialty
• Physician Assistant in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2018; 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.

Verify at the official NPI Registry.