Shaun Kelly Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

3551 Roger Brooke Dr Ofc
Fort Sam Houston, TX 78234-4504

Phone

(210) 539-9582

Fax

(210) 539-9582

NPI assigned

Sep 13, 2011

Last updated

Apr 25, 2023By 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 TX

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, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

TMC Provider Group PLLCGroup PAC ID 6305149121, 213 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• TMC Provider Group PLLC

  dba Texas MedClinic

  • Urgent Care Clinic/Center
  • San Antonio, TX
  • NPI 1053784660
  Medicare reassignment Care Compare group
• TMC Provider Group PLLC

  dba Texas MedClinic

  • Urgent Care Clinic/Center
  • San Antonio, TX
  • NPI 1033968789
  NPD
• TMC Provider Group PLLC

  dba Texas MedClinic

  • Urgent Care Clinic/Center
  • San Antonio, TX
  • NPI 1487019287
  NPD

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

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682380800000",
    "number": "1821370214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR OFC",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "719-526-2092",
            "fax_number": "210-539-9582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR OFC",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "210-539-9582",
            "fax_number": "210-539-9582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHAUN",
        "middle_name": "KELLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-13",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Waldron Johnson, DO
• Peter Christian Johnson, M.D.
• Rasheedah Johnson
• Rebecca Johnson, MS, RD, LD
• Robyn Lynn Johnson, LCSW
• Tammy L Johnson
• Kyle Matthew Johnston, PA-C
• Austin Dale Jones, DO
• Christy Wilea Jones, M.D.
• Cynthia Ann Jones, OTR/L

• Physician Assistant in Fort Sam Houston, TX
• Providers in Fort Sam Houston, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2023; 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.