Jedidiah Johnson, PA-C
Individual provider Active NPI Diagnostic Radiology Physician · Mesa, AZ
NPI 1689155673 · NPPES record last updated Jan 30, 2019
Key facts
- NPI
- 1689155673
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 7194 (AZ)
- Practice address
- 6424 E Broadway Rd Ste 101
Mesa, AZ 85206-1750 - Phone
- (480) 456-9000
- NPI assigned
- Aug 27, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sonoran Radiology LTD
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
- Banner Baywood Medical Center
- Banner Ocotillo Medical Center
- Banner Desert Medical Center
- Banner Casa Grande Medical Center
- Banner Ironwood Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190325001129 | AZ | Practitioner - Physician Assistant | 5496095705 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Associated Radiologists LTD | Past | Accepting new 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 |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Diagnostic Radiology Physician | 2085R0202X | 7194 | AZ | Yes |
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
Other providers in Mesa, AZ
- Eric P Johnson
- Erik Adair Johnson
- Fredrick G. Johnson
- Hebert Johnson
- Heidi Johnson
- Jennifer Johnson
- John Johnson Jr.
- Julie Johnson
- Kaitlynn Johnson
- Katherine Grace Johnson
All providers in Mesa, AZ · Diagnostic Radiology Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.