Evan Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-2622 Issued in ID

Practice address

1252 Bennett Ave Ste B
Burley, ID 83318-2664

Phone

(208) 647-0656

NPI assigned

Jun 13, 2022

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 ID

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physicians Immediate Care of Twin Falls PAGroup PAC ID 0143460717, 9 clinicians

North Canyon Medical Center IncGroup PAC ID 0941371439, 73 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cassia Regional Hospital Hospital, Burley, ID, CCN 131326
• St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: evan.johnson.1@29843.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.

• North Canyon Medical Center Inc.

  dba North Canyon Medical Center

  • Critical Access Hospital
  • Gooding, ID
  • NPI 1609046671
  Medicare reassignment Care Compare group NPD
• Physicians Immediate Care of Twin Falls PA

  dba Physicians Immediate Care Center

  • Urgent Care Clinic/Center
  • Twin Falls, ID
  • NPI 1114141090
  Medicare reassignment Care Compare group
• North Canyon Medical Center, Inc.

  dba North Canyon Imaging Center Twin Falls

  • Radiology Clinic/Center
  • Twin Falls, ID
  • NPI 1700641636
  NPD
• Page Family Medicine

  • Family Medicine Physician
  • Burley, ID
  • NPI 1487151882
  NPD (past)
• Inland Cardiology Associates, P.S.

  • Cardiovascular Disease Physician
  • Spokane, WA
  • NPI 1679522106
  NPD (past)

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

• Ihc Health Services, Inc.

  dba Intermountain Health Cassia Regional Hospital

  • General Acute Care Hospital
  • Burley, ID
  • NPI 1497865315
  Care Compare affiliation
• St. Luke's Magic Valley Regional Medical Center, LTD.

  dba St Lukes Magic Valley - Air Ambulance

  • General Acute Care Hospital
  • Twin Falls, ID
  • NPI 1932154705
  Care Compare affiliation

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

{
    "created_epoch": "1655078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699056000000",
    "number": "1912637042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1252 BENNETT AVE STE B",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182664",
            "telephone_number": "208-647-0656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1252 BENNETT AVE STE B",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182664",
            "telephone_number": "208-647-0656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "EVAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-13",
        "last_updated": "2023-11-04",
        "certification_date": "2023-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria G Jensen, RN, ICADC
• William F Jensen, MBA, ICADC
• Melvin Terry Jeppson, M.D.
• Alicia Johnson
• Brian Johnson, PA-C
• Jared C Johnson, D.D.S.
• Anita Engstrom Jones, LCPC, LMFT
• Jennifer Anne Jones, COUI-9582
• Joseph R. Petersen, M.D.
• Joseph R. Petersen, M.D. (Orthopedic Surgery Center)

• Physician Assistant in Burley, ID
• Providers in Burley, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.