Individual provider Active NPI

Elizabeth D Johnston, PA-C

  • Physician Assistant
  • Bridgeport, CT
National Provider Identifier
1699100347
Registry record updated Jul 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
267 Grant St
Bridgeport, CT 06610-2805
Phone
(203) 384-3199
NPI assigned
Sep 12, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA Primary

Addresses

Primary practice location

267 Grant St
Bridgeport, CT 06610-2805

Mailing address

267 Grant St
Bridgeport, CT 06610-2805
Phone (203) 384-3199

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20160803001504 MA Practitioner - Physician Assistant 0941525422 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vantage Healthcare LLCGroup PAC ID 8224361191, 72 clinicians

Practice addresses (Care Compare)

119 E Central St
Natick, MA 01760-3624
Phone (774) 231-0070

12 Bluebird Rd
Wellesley, MA 02481-3503
Phone (774) 309-4129

20 Summer St
Watertown, MA 02472-3484
Phone (617) 924-8100

301 S Huntington Ave
Jamaica Plain, MA 02130-4807
Phone (857) 307-3300

421 Bolton St
Marlborough, MA 01752-4198
Phone (508) 318-6837

615 Heath St
Chestnut Hill, MA 02467-2160
Phone (617) 244-6400

675 S Main St
Sharon, MA 02067-2834
Phone (781) 784-0111

68 Commonwealth Ave
Concord, MA 01742-2967
Phone (978) 369-4728

730 Madison St
Wrentham, MA 02093-1640
Phone (781) 867-2050

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3149CTMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Steward Medical Group, Inc CurrentSince May 14, 2016 Accepting new patients
Steward Medical Group, Inc CurrentSince May 14, 2016 Accepting new patients

Locations

11 Nevins St
Ste 201
Brighton, MA 02135
Phone (617) 789-2442

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1378944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404864000000",
    "number": "1699100347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "267 GRANT ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066102805",
            "telephone_number": "203-384-3199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 GRANT ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066102805",
            "telephone_number": "203-384-3199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "ELIZABETH",
        "middle_name": "D",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-12",
        "last_updated": "2014-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

Verify at the official NPI Registry.