Individual provider Active NPI

Breanna Johnson

  • Nurse Practitioner
  • Riverside, CA
National Provider Identifier
1760077093
Registry record updated Dec 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95016797 Issued in CA
Practice address
4445 Magnolia Ave
Riverside, CA 92501-4135
Phone
(951) 788-3000
NPI assigned
Mar 8, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 95016797 CA Primary

Addresses

Primary practice location

4445 Magnolia Ave
Riverside, CA 92501-4135

Mailing address

4222 E Brown Rd Unit 13
Mesa, AZ 85205-4056
Phone (909) 731-1429

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20221031001836 AZ Practitioner - Nurse Practitioner 6305213679 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atlas Medical Aco LLCGroup PAC ID 1456885227, 50 clinicians
Century Care IncGroup PAC ID 3971665605, 51 clinicians

Practice addresses (Care Compare)

7227 E Baseline Rd
Suite 126
Mesa, AZ 85209-5006
Phone (480) 868-9650

Hospital & facility affiliations

  • Aegis Homecare, Inc Home health agency, Mesa, AZ, CCN 037422
  • Aegis Hospice, Inc. Hospice, Mesa, AZ, CCN 031613

Merit-based Incentive Payment System (MIPS)

Final score
77.24 of 100Reported as group
Quality
66.21
Improvement activities
40
Cost
66.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95016797CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Atlas Medical Aco LLC CurrentSince Apr 1, 2025 Accepting new patients
Century Care Inc CurrentSince Nov 29, 2023 Accepting new patients

Locations

7227 E Baseline Rd
Ste 126
Mesa, AZ 85209
Phone (907) 215-4846

Interoperability endpoints

  • Direct secure messaging: breanna.johnson@57560418353156.direct.elationemr.com

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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": "1615161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1760077093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4222 E BROWN RD UNIT 13",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852054056",
            "telephone_number": "909-731-1429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4445 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925014135",
            "telephone_number": "951-788-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BREANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-08",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95016797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.