Individual provider Active NPI

Abigail K Johnson

  • Physician Assistant
  • Highland, IL
National Provider Identifier
1780366815
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2024034310 Issued in MO
Practice address
213 Mirabeau
Highland, IL 62249-4898
Phone
(618) 334-7897
NPI assigned
Aug 7, 2023
Last updated
Oct 17, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2024034310 MO Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

213 Mirabeau
Highland, IL 62249-4898

Mailing address

213 Mirabeau
Highland, IL 62249-4898
Phone (618) 334-7897

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20240913002876 MO Practitioner - Physician Assistant 5294275442 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America LLC CurrentSince Aug 15, 2024 Accepting new patients
Cep America LLC CurrentSince Aug 15, 2024 Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 900-3125

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328

Interoperability endpoints

  • Direct secure messaging: ajohnson505569@direct-ehr-ssmhc.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1691366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1780366815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 MIRABEAU",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622494898",
            "telephone_number": "618-334-7897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 MIRABEAU",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622494898",
            "telephone_number": "618-334-7897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ABIGAIL",
        "middle_name": "K",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-07",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2024034310",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Highland, IL

Sources for this page

Verify at the official NPI Registry.