Jerry Allen Johnson, PA-C

Key facts

NPI

1780779140

Entity type

Individual (NPI type 1)

Primary specialty

Physician Assistant 363A00000X

License

PA00163 (TX)

Practice address

1201 Sam Bass Road
Round Rock, TX 78681-4137

Phone

(512) 388-1861

Fax

(512) 388-0373

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

No

Organizations & group practices 4

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.

• Fred E Griffiths Geriatric Medicine (Family Medicine) Physician · Austin, TX · NPI 1609821719
  NPD (past)
• House Call Doctors Texas PLLC Family Medicine Physician · Austin, TX · NPI 1992731814
  NPD (past)
• Medspring of Texas, PA Urgent Care Clinic/Center · Austin, TX · NPI 1811286354
  NPD (past)
• Round Rock Mental Health PA Psychiatry Physician · Round Rock, TX · NPI 1538338306
  NPD (past) MEDICAL

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

HHS exclusion list flag

The National Provider Directory flags this NPI as appearing on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 4, 2008.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220486400000",
    "number": "1780779140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 SAM BASS ROAD",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786814137",
            "telephone_number": "512-388-1861",
            "fax_number": "512-388-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 SAM BASS ROAD",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786814137",
            "telephone_number": "512-388-1861",
            "fax_number": "512-388-0373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JERRY",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2008-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA00163",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA00163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Round Rock, TX

• Carldale Johnson
• Carra Johnson
• Elisha Faye Johnson, LCSW
• James G. Johnson, JAMES JOHNSON
• Jasmine Johnson
• Joffre Edward Johnson, M.D.
• John Gordon Johnson, D.O.
• Julie Johnson, PT
• Michelle Johnson, PT
• Renese M. Johnson, LPC

All providers in Round Rock, TX · Physician Assistant in Texas