Elliot Paul Johnson, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

085005130 Issued in IL

Practice address

2900 Foxfield Rd
Suite 102
St Charles, IL 60174-5799

Phone

(630) 377-1188

Fax

(630) 377-7360

NPI assigned

Aug 11, 2014

Last updated

Aug 11, 2014By the provider in NPPES

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 IL

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Genesis Orthopedics and Sports Medicine LLCGroup PAC ID 7618955808, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Genesis Orthopedics & Sports Medicine LLC

  • Orthopaedic Surgery Physician
  • St Charles, IL
  • NPI 1346389061
  Medicare reassignment Care Compare group
• Genesis Orthopedics & Sports Medicine LLC

  dba Genesis Orthopedics & Sports Medicine DME

  • Durable Medical Equipment & Medical Supplies
  • Oak Brook, IL
  • NPI 1467954016
  NPD

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

{
    "created_epoch": "1407715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407715200000",
    "number": "1780093187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 FOXFIELD RD",
            "address_2": "SUITE 102",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745799",
            "telephone_number": "630-377-1188",
            "fax_number": "630-377-7360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 FOXFIELD RD",
            "address_2": "SUITE 102",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601745799",
            "telephone_number": "630-377-1188",
            "fax_number": "630-377-7360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ELLIOT",
        "middle_name": "PAUL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-11",
        "last_updated": "2014-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085005130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Charles Johnsen, M.S.
• Britt Johnson-Dunlop, RBT-18-60264
• Brittany Selina Johnson
• Brooke N Johnson, PA-C
• Courtney Johnson
• Evan Dean Johnson, M.D.
• Gregory Johnson, M.S., CCC-SLP
• Katie Lynne Johnson, DC, LAC
• Kelsey Teresa Johnson
• Lawrence L Johnson, M.D.

• Surgical Physician Assistant in St Charles, IL
• Providers in St Charles, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2014; 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.