Jenelle Kristine Johnson

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

148759 Issued in AK

Practice address

34300 S Talkeetna Spur Road
Talkeetna, AK 99676-9701

Phone

(907) 733-2273

NPI assigned

Sep 3, 2018

Sex

Female

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 AK

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

University of Washington School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sunshine Community Health Center IncGroup PAC ID 3173415635, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mat-Su Regional Medical Center Hospital, Palmer, AK, CCN 020006

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: jenelle.johnson.1@27018.direct.athenahealth.com

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.

• Sunshine Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Talkeetna, AK
  • NPI 1922071117
  Medicare reassignment Care Compare group
• Sunshine Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Willow, AK
  • NPI 1699892307
  NPD

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

• Mat-Su Valley Medical Center LLC

  • General Acute Care Hospital
  • Palmer, AK
  • NPI 1417975061
  Care Compare affiliation

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

{
    "created_epoch": "1535932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1891277174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HC 89 BOX 8190",
            "city": "TALKEETNA",
            "state": "AK",
            "postal_code": "996769701",
            "telephone_number": "907-733-2273",
            "fax_number": "907-733-1735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34300 S TALKEETNA SPUR ROAD",
            "city": "TALKEETNA",
            "state": "AK",
            "postal_code": "996769701",
            "telephone_number": "907-733-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JENELLE",
        "middle_name": "KRISTINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-03",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "148759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Bradley
• Lauren Champagne, LCSW
• Paul Forman, MD
• William Todd Frantz, D.M.D.
• George Baryon Hightower, M.D.
• Anna Jolley
• Keith L Kehoe, PAC
• Tanya Jean Korta, MED
• Peggy Irene Marsh, R.N.
• Tina McCluskey

• Physician Assistant in Talkeetna, AK
• Providers in Talkeetna, AK by specialty
• Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; 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.