Jaclyn Marie Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

332573 Issued in LA

Practice address

7777 Hennessy Blvd Ste 2003B
Baton Rouge, LA 70808-4300

Phone

(337) 534-0952

NPI assigned

May 27, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

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, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Our Lady of the Lake Regional Medical Center Hospital, Baton Rouge, LA, CCN 190064
• Lake Charles Memorial Hospital Hospital, Lake Charles, LA, CCN 190060

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Professional Emergency Medicine Management -- Lake Charles LLC

  • Emergency Medicine Physician
  • Lake Charles, LA
  • NPI 1023430766
  Medicare reassignment
• Thibodaux Emergency Physicians Group LLC

  • Emergency Medicine Physician
  • Thibodaux, LA
  • NPI 1568910503
  Medicare reassignment

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

• Our Lady of the Lake Hospital Inc.

  • General Acute Care Hospital
  • Baton Rouge, LA
  • NPI 1366436123
  Care Compare affiliation
• Southwest Louisiana Hospital Association Inc

  • Gastroenterology Physician
  • Lake Charles, LA
  • NPI 1285351411

  Hospital

  Care Compare affiliation
• Southwest Louisiana Hospital Association Inc

  • Rheumatology Physician
  • Lake Charles, LA
  • NPI 1659424075

  Hospital

  Care Compare affiliation
• Southwest Louisiana Hospital Association Inc

  • General Acute Care Hospital
  • Lake Charles, LA
  • NPI 1972549855
  Care Compare affiliation

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

{
    "created_epoch": "1653609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658102400000",
    "number": "1831838960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7777 HENNESSY BLVD STE 2003B",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084300",
            "telephone_number": "337-534-0952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 HENNESSY BLVD STE 2003B",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084300",
            "telephone_number": "337-534-0952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACLYN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-27",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "LA",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "332573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hayley Beth Johnson
• Ilyssa Johnson
• Inga Renee Johnson, LPN
• Jacinth Johnson
• Jack Allen Johnson Jr., PH.D.
• Jakira J Johnson
• Janice B Johnson, LPN
• Jantrell Ronalynn Johnson
• Jaquencia D Johnson, LMT
• Jasma Chena Johnson

• Physician Assistant in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; 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.