Individual provider Active NPI

Amanda Jean Johnson, PA-C

  • Surgical Physician Assistant
  • Madison, WI
National Provider Identifier
1679569024
Registry record updated Jan 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
2394 Issued in WI
Practice address
4621 Eastpark Blvd
Madison, WI 53718-2000
Phone
(608) 915-0100
NPI assigned
Sep 21, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 2394 WI Primary
Medical Physician Assistant 363AM0700X 2394-023 WI

Addresses

Primary practice location

4621 Eastpark Blvd
Madison, WI 53718-2000

Mailing address

7974 Uw Health CT
Middleton, WI 53562-5531
Phone (608) 260-6000

Other practice location 1

1821 S Stoughton Rd
Dean Medical Center
Madison, WI 53716-2257
Phone (608) 260-6000

Other identifiers 2

IdentifierTypeStateIssuer
1679569024MedicaidWI
60959OtherWIDEAN HEALTH INSURANCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20090617000381 WI Practitioner - Physician Assistant 1355366394 Reassigns benefits to 2 organizations
I20170501001959 IL Practitioner - Physician Assistant 1355366394 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Health System CorporationGroup PAC ID 7416860440, 749 clinicians
University of Wisconsin Medical Foundation IncGroup PAC ID 6608785464, 2,537 clinicians

Practice addresses (Care Compare)

1000 Mineral Point Ave
Janesville, WI 53548-2940
Phone (608) 756-6508

4621 Eastpark Blvd
Madison, WI 53718-2000
Phone (608) 914-0100

Hospital & facility affiliations

  • University of Wi Hospitals & Clinics Authority Hospital, Madison, WI, CCN 520098
  • Mercy Health System Corp Hospital, Janesville, WI, CCN 520066
  • Borgess Medical Center Hospital, Kalamazoo, MI, CCN 230117

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2394-023WIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation CurrentSince Jun 10, 2013 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Feb 2, 2026 Accepting new patients
Mercy Health System Corporation CurrentSince Jun 10, 2013 Accepting new patients
University of Wisconsin Medical Foundation, Inc CurrentSince Feb 2, 2026 Accepting new patients
Mercy Health System Corporation Current Accepting new patients
University of Wisconsin Medical Foundation Inc Past Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

2400 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-6310

2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510

402 W Lake St
Friendship, WI 53934
Phone (608) 339-3331

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

250 Doctors Ct
Johnson Creek, WI 53038
Phone (920) 699-1056

600 Highland Ave
Madison, WI 53792
Phone (608) 263-0325

4621 Eastpark Blvd
Madison, WI 53718
Phone (608) 914-0100

1821 S Stoughton Rd
Madison, WI 53716
Phone (608) 260-6000

7974 Uw Health Ct
Middleton, WI 53562
Phone (608) 829-5270

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

2977 Cty Cx
Portage, WI 53901
Phone (608) 742-3004

Interoperability endpoints

  • Direct secure messaging: ajohnson25375@direct.mhemail.org

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 and National Provider Directory roles.

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": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769731200000",
    "number": "1679569024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7974 UW HEALTH CT",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625531",
            "telephone_number": "608-260-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4621 EASTPARK BLVD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537182000",
            "telephone_number": "608-915-0100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1821 S Stoughton Rd",
            "address_2": "Dean Medical Center",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537162257",
            "country_code": "US",
            "telephone_number": "608-260-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "AMANDA",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-21",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WI",
            "license": "2394",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "2394-023",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679569024",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH INSURANCE",
            "identifier": "60959",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.