NPIMap

Individual provider Active NPI

Kelly Johnson

  • Physician Assistant
  • Aspen, CO
National Provider Identifier
1720408172
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0004662 Issued in CO
Practice address
401 Castle Creek Rd Ste 2100
Aspen, CO 81611-1159
Phone
(970) 476-1100
Fax
(970) 479-5835
NPI assigned
Apr 24, 2014
Last updated
Jul 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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 60610430 WA
Physician Assistant 363A00000X PA.0004662 CO Primary

Addresses

Primary practice location

401 Castle Creek Rd Ste 2100
Aspen, CO 81611-1159

Mailing address

301 S 320TH St
Federal Way, WA 98003-5200

Other practice location 1

301 S 320th St
Federal Way, WA 98003-5200
Phone (253) 874-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20161228000143 CO Practitioner - Physician Assistant 5193028082 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Steadman Clinic Professional LLCGroup PAC ID 7719876226, 77 clinicians

Practice addresses (Care Compare)

181 W Meadow Dr
Suite 400
Vail, CO 81657-5058
Phone (970) 476-1100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60610430WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aspen Valley Hospital Clinics, PLLC CurrentSince Jul 28, 2018 Accepting new patients
Aspen Valley Hospital District Clinics CurrentSince Jul 28, 2018 Accepting new patients
Aspen Valley Hospital District CurrentSince Oct 16, 2016 Accepting new patients
Steadman Clinic Professional LLC CurrentSince Dec 1, 2020 Accepting new patients
Aspen Valley Hospital District CurrentSince Oct 16, 2016 Accepting new patients
Steadman Clinic Professional LLC CurrentSince Dec 1, 2020 Accepting new patients

Locations

401 Castle Creek Rd
Aspen, CO 81611
Phone (970) 544-1192

401 Castle Creek Rd
Ste 2100
Aspen, CO 81611
Phone (970) 544-1289

200 Robinson St
Ste C300
Basalt, CO 81621

322 Beard Creek Rd
Edwards, CO 81632
Phone (970) 569-7429

181 W Meadow Dr
Ste 400
Vail, CO 81657
Phone (970) 680-0795

Interoperability endpoints

  • FHIR API: https://epicproxy.et1254.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 6

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 6

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": "1398297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1720408172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 S 320TH ST",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980035200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 CASTLE CREEK RD STE 2100",
            "city": "ASPEN",
            "state": "CO",
            "postal_code": "816111159",
            "telephone_number": "970-476-1100",
            "fax_number": "970-479-5835"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 S 320th St",
            "address_purpose": "LOCATION",
            "city": "Federal Way",
            "state": "WA",
            "postal_code": "980035200",
            "country_code": "US",
            "telephone_number": "253-874-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-24",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "60610430",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0004662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aspen, CO

Sources for this page

Verify at the official NPI Registry.