Active NPI
Jennifer L Johnson, PA-C
- Medical Physician Assistant
- Pawley's Island, SC
National Provider Identifier
1760588388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- A1133
- Practice address
- 9699 Ocean Hwy
Pawleys Island, SC 29585-7425 - Phone
- (843) 237-4296
- Fax
- (843) 237-0495
- NPI assigned
- Sep 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | A1133 | SC | Primary |
Addresses
Primary practice location
9699 Ocean Hwy
Pawleys Island, SC 29585-7425
Mailing address
PO Box 1209
Murrells Inlet, SC 29576-1209
Phone (843) 652-8220
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A1133 | Other | SC | STATE MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1133 | SC | MD | Athletic Trainer |
| A1133 | SC | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indigo Vision Center PA | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Optometrist
- Georgetown, SC
- NPI 1700071149
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437609600000",
"number": "1760588388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1209",
"city": "MURRELLS INLET",
"state": "SC",
"postal_code": "295761209",
"telephone_number": "843-652-8220",
"fax_number": "843-527-7080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9699 OCEAN HWY",
"city": "PAWLEYS ISLAND",
"state": "SC",
"postal_code": "295857425",
"telephone_number": "843-237-4296",
"fax_number": "843-237-0495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JENNIFER",
"middle_name": "L",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-15",
"last_updated": "2015-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "SC",
"license": "A1133",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE MEDICAL LICENSE",
"identifier": "A1133",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pawley's Island, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.