Sandrivette Johnson, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

201614 Issued in NC

Practice address

5904 Six Forks Rd Ste 211
Raleigh, NC 27609-8228

Phone

(984) 242-0510

Fax

(984) 242-0520

NPI assigned

Jul 21, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Nurse Practitioner

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Midtown Dermatology, PCGroup PAC ID 2062632599, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Midtown Dermatology, PC

  • Dermatology Physician
  • Raleigh, NC
  • NPI 1205242252
  Medicare reassignment Care Compare group NPD
• Atlantic Neurosurgery Consultants, PA

  • Neurological Surgery Physician
  • Rocky Mount, NC
  • NPI 1538124177
  NPD (past)

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1740201458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5904 SIX FORKS RD STE 211",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276098228",
            "telephone_number": "984-242-0510",
            "fax_number": "984-242-0520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5904 SIX FORKS RD STE 211",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276098228",
            "telephone_number": "984-242-0510",
            "fax_number": "984-242-0520"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4056 Capital Dr",
            "address_purpose": "LOCATION",
            "city": "Rocky Mount",
            "state": "NC",
            "postal_code": "278043123",
            "country_code": "US",
            "telephone_number": "984-242-0510",
            "fax_number": "984-242-0520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SANDRIVETTE",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2022-07-21",
        "certification_date": "2020-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "201614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "NCY997D895",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P02076810",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sandrivettejohnson@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "Nextech DirectAddress",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "5904 Six Forks Rd Ste 211",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276098228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ruth Johnson
• Ryan Christopher Johnson, M.D.
• Ryan Zachary Johnson, PA-C
• Sally Johnson
• Samaria Faith Johnson
• Sarah Lane Johnson, M.S., CCC-SLP
• Shalon Yvette Johnson
• Shaniece Johnson
• Shaughnessy Burnett Johnson
• Shelby Johnson

• Nurse Practitioner in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.