Edward Alan Johnson, PAC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

PA3355 Issued in FL

Practice address

1099 A1A Beach Blvd
St Augustine, FL 32080

Phone

(904) 471-9104

Fax

(904) 461-3386

NPI assigned

Aug 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Physician Assistant

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Island Doctors Intrastate LLCGroup PAC ID 5395161186, 74 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Island Doctors Intrastate LLC

  • Primary Care Clinic/Center
  • St Augustine, FL
  • NPI 1568083889
  Medicare reassignment Care Compare group
• Roy H Hinman MD PA

  dba Island Doctors

  • Family Medicine Physician
  • St Augustine, FL
  • NPI 1649383845
  Medicare reassignment
• Florida Em-I Medical Services PA

  • Emergency Medicine Physician
  • Lakeland, FL
  • NPI 1871542720
  NPD (past)
• Nes of Florida Inc

  • Emergency Medicine Physician
  • Ocala, FL
  • NPI 1598707689
  NPD (past)
• Osprey Emergency Physicians LLC

  • Emergency Medicine Physician
  • Lakeland, FL
  • NPI 1063461960
  NPD (past)

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760595961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 13TH STREET",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "32080",
            "telephone_number": "904-540-7740",
            "fax_number": "904-461-3386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1099 A1A BEACH BLVD",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "32080",
            "telephone_number": "904-471-9104",
            "fax_number": "904-461-3386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "EDWARD",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "PA3355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Achisa Johnson
• Amber Sherrie Johnson
• Ashlee Johnson, MPT
• Brianna Johnson
• Douglas L Johnson, DMD
• Erin Marie Johnson, LMT
• Grace Elizabeth Johnson
• Judith L Johnson, LCSW, LPC
• Karen M Johnson
• Kerri Miranda Johnson, LM, CPM

• Family Medicine Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.