Ben Douglas Johnson, PA-C
Individual provider Active NPI Medical Physician Assistant · Phoenix, OR
NPI 1720152465 · NPPES record last updated Feb 9, 2024
Key facts
- NPI
- 1720152465
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA00825 (OR)
- Practice address
- 205 N Phoenix Rd Ste 430
Phoenix, OR 97535-9108 - Phone
- (541) 778-4517
- Fax
- (541) 833-0995
- NPI assigned
- Nov 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- G Street Integrated Health
Practice addresses (Care Compare)
1435 G St
Springfield, OR 97477-4113
Phone (541) 735-9420
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- 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 |
|---|---|---|---|---|
| I20040224000799 | OR | Practitioner - Physician Assistant | 2567358856 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Associate of Science, Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Icco, LLC | Current |
Accepting new patients | |
| Cep America LLC | Past | Accepting new patients | |
| Cep America LLC | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/BCEDDD/Endpoint/BCEDDD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA00825 | OR | |
| Medical Physician Assistant | 363AM0700X | PA00825 | OR | Yes |
Addresses
Primary practice location
205 N Phoenix Rd Ste 430
Phoenix, OR 97535-9108
Mailing address
205 N Phoenix Rd Ste 430
Phoenix, OR 97535-9108
Phone (541) 778-4517
Other providers in Phoenix, OR
- Emily E Hinman
- Skyla Kenzie Ihne Gazeley
- Holly Ivie
- Jamie R White DMD PC
- Paul George Jendre
- Katelyn R Jones
- Jose Luis Garcia Ma Ms LPC Mental Health Counseling
- Serob Karapetyan
- Karla Reinhart LLC
- Kristin Janelle Karns
All providers in Phoenix, OR · Medical Physician Assistant in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2024. 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.