NPIMap

Individual provider Active NPI

Jedidiah Johnson, PA-C

  • Diagnostic Radiology Physician
  • Mesa, AZ
National Provider Identifier
1689155673
Registry record updated Jan 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
7194 Issued in AZ
Practice address
6424 E Broadway Rd Ste 101
Mesa, AZ 85206-1750
Phone
(480) 456-9000
NPI assigned
Aug 27, 2018
Last updated
Jan 30, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2019

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
Diagnostic Radiology Physician 2085R0202X 7194 AZ Primary

Addresses

Primary practice location

6424 E Broadway Rd Ste 101
Mesa, AZ 85206-1750

Mailing address

1201 S Alma School Rd Ste 14000
Mesa, AZ 85210-2096

Other practice location 1

1201 S Alma School Rd Ste 14000
Mesa, AZ 85210-2096
Phone (480) 545-9779

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20190325001129 AZ Practitioner - Physician Assistant 5496095705 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sonoran Radiology LTDGroup PAC ID 3375964505, 466 clinicians

Practice addresses (Care Compare)

1114 W Thunderhill Dr
Phoenix, AZ 85045-0300
Phone (832) 915-2534

1400 S Dobson Rd
Mesa, AZ 85202-4707
Phone (832) 915-2534

1405 S Alma School Rd
Chandler, AZ 85286-7144
Phone (832) 915-2534

1435 S Alma School Rd
Chandler, AZ 85286-7144
Phone (832) 915-2534

1800 E Florence Blvd
Casa Grande, AZ 85122-5303
Phone (832) 915-2534

2050 W Southern Ave
Apache Junction, AZ 85120-7305
Phone (832) 915-2534

37000 N Gantzel Rd
San Tan Valley, AZ 85140-7303
Phone (832) 915-2534

6644 E Baywood Ave
Mesa, AZ 85206-1747
Phone (832) 915-2534

6750 E Baywood Ave
Mesa, AZ 85206-1749
Phone (832) 915-2534

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
East Valley Diagnostic Imaging LLC Past Accepting new patients
Banner Imaging Services LLC Past Accepting new patients
Banner Imaging Services LLC Diagnostic Radiology Past Accepting new patients
Associated Radiologists LTD Past Accepting new patients

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 5

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": "1535328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548806400000",
    "number": "1689155673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 S ALMA SCHOOL RD STE 14000",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852102096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6424 E BROADWAY RD STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061750",
            "telephone_number": "480-456-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 S Alma School Rd Ste 14000",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852102096",
            "country_code": "US",
            "telephone_number": "480-545-9779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JEDIDIAH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-27",
        "last_updated": "2019-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "7194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.