NPIMap

Individual provider Active NPI

Trenton Ryan Johnson

  • Physician Assistant
  • Clendenin, WV
National Provider Identifier
1831798321
Registry record updated Feb 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2508 Issued in WV
Practice address
107 Koontz Ave Ste 200
Clendenin, WV 25045-9581
Phone
(304) 548-7272
Fax
(304) 542-7149
NPI assigned
Oct 26, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2022

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
Physician Assistant 363A00000X 2508 WV Primary

Addresses

Primary practice location

107 Koontz Ave Ste 200
Clendenin, WV 25045-9581

Mailing address

107 Koontz Ave Ste 200
Clendenin, WV 25045-9581
Phone (304) 548-7272

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210820001462 WV Practitioner - Physician Assistant 7810392370 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cabin Creek Health Center IncGroup PAC ID 2466431101, 41 clinicians

Practice addresses (Care Compare)

107 Koontz Ave
Suite 200
Clendenin, WV 25045-9581
Phone (304) 548-7272

6135 Sissonville Dr
Charleston, WV 25312-9444
Phone (304) 984-1576

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, South Charleston, WV, CCN 517048
  • Charleston Area Medical Center Hospital, Charleston, WV, CCN 510022

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2508WVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cabin Creek Health Center, Inc. CurrentSince Jul 26, 2021 Accepting new patients

Locations

1 Warrior Way
Ste 103
Belle, WV 25015
Phone (304) 949-3591

4602 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 205-7535

6135 Sissonville Dr
Charleston, WV 25312
Phone (304) 984-1576

104 Alex Ln
Charleston, WV 25304
Phone 30473420401319

107 Koontz Ave
Ste 200
Clendenin, WV 25045
Phone (304) 548-7272

Interoperability endpoints

  • Direct secure messaging: trenton.johnson.1@7267.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1603670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645833600000",
    "number": "1831798321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 KOONTZ AVE STE 200",
            "city": "CLENDENIN",
            "state": "WV",
            "postal_code": "250459581",
            "telephone_number": "304-548-7272",
            "fax_number": "304-542-7149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 KOONTZ AVE STE 200",
            "city": "CLENDENIN",
            "state": "WV",
            "postal_code": "250459581",
            "telephone_number": "304-548-7272",
            "fax_number": "304-542-7149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TRENTON",
        "middle_name": "RYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-26",
        "last_updated": "2022-02-26",
        "certification_date": "2022-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "2508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clendenin, WV

Sources for this page

Verify at the official NPI Registry.