Individual provider Active NPI

Stephen Wesley Johnson, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Panama City Beach, FL
National Provider Identifier
1679924716
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN9307095 Issued in FL
Practice address
2605 Thomas Dr Ste 120
Panama City Beach, FL 32408-6254
Phone
(850) 215-7095
Fax
(850) 215-7096
NPI assigned
Jun 30, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN9307095 FL Primary

Addresses

Primary practice location

2605 Thomas Dr Ste 120
Panama City Beach, FL 32408-6254

Mailing address

2605 Thomas Dr Ste 120
Panama City Beach, FL 32408-6254
Phone (850) 215-7095

Other identifiers 2

IdentifierTypeStateIssuer
APRN9307095OtherFLFLORIDA APRN LICENSE
118056200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20161216001709 FL Practitioner - Nurse Practitioner 6800176447 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2605 Thomas Dr
Suite 120
Panama City, FL 32408-6254
Phone (850) 502-6217

Hospital & facility affiliations

  • Ascension Sacred Heart Bay Hospital, Panama City, FL, CCN 100026
  • HCA Florida Gulf Coast Hospital Hospital, Panama City, FL, CCN 100242

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Emerald Coast Rheumatology LLC CurrentSince Nov 30, 2020 Accepting new patients
Johnsons Family Medicine LLC CurrentSince Feb 15, 2023 Accepting new patients
Emerald Coast Internal Medicine and Geriatrics LLC Past Accepting new patients

Locations

3890 Jenks Ave
Lynn Haven, FL 32444
Phone (850) 215-6400

Interoperability endpoints

  • Direct secure messaging: stephen.johnson.1@28129.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/3219/brand/1/csg/1/fhir/r4

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 2

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": "1467244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1679924716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 THOMAS DR STE 120",
            "city": "PANAMA CITY BEACH",
            "state": "FL",
            "postal_code": "324086254",
            "telephone_number": "850-215-7095",
            "fax_number": "850-215-7096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 THOMAS DR STE 120",
            "city": "PANAMA CITY BEACH",
            "state": "FL",
            "postal_code": "324086254",
            "telephone_number": "850-215-7095",
            "fax_number": "850-215-7096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "STEPHEN",
        "middle_name": "WESLEY",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-30",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN9307095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA APRN LICENSE",
            "identifier": "APRN9307095",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118056200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Panama City Beach, FL

Sources for this page

Verify at the official NPI Registry.