Johnny Staton, LSA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

SA00687 Issued in TX

Practice address

1208 Paintbrush St
Mesquite, TX 75149

Phone

(214) 227-2457

Fax

(214) 764-0880

NPI assigned

Apr 1, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Preferred Surgical Associates of Texas

  • Surgical Physician Assistant
  • Mesquite, TX
  • NPI 1942717301
  NPD (past) Authorized official

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

{
    "created_epoch": "1491004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556150400000",
    "number": "1922530591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 938",
            "city": "ROWLETT",
            "state": "TX",
            "postal_code": "750300938",
            "telephone_number": "214-227-2457",
            "fax_number": "214-764-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 PAINTBRUSH ST",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "75149",
            "telephone_number": "214-227-2457",
            "fax_number": "214-764-0880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "445 E Fm 1382",
            "address_2": "3-195",
            "address_purpose": "LOCATION",
            "city": "Cedar Hill",
            "state": "TX",
            "postal_code": "751046047",
            "country_code": "US",
            "telephone_number": "214-980-9437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STATON",
        "first_name": "JOHNNY",
        "credential": "LSA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-01",
        "last_updated": "2019-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "SA00687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS MEDICAL BOARD",
            "identifier": "SA00687",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kimmie Steed
• Ralph G Stein, D.O.
• Michelle Steinhagen
• Olga Stepanchenko, DDS
• Michel Khamis Stephan, MD

• Surgical Physician Assistant in Mesquite, TX
• Providers in Mesquite, TX by specialty
• Surgical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.