Mackenzie Sue Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5315236633 Issued in MI

Practice address

1670 E Sherman Blvd Ste 100
Muskegon, MI 49444-1863

Phone

(231) 672-3600

Fax

(231) 672-3601

NPI assigned

May 23, 2023

Last updated

Sep 26, 2023By the provider in NPPES

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 MI

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

Accepts the Medicare-approved amount as payment in full

Group practices

Ecs Western Michigan PCGroup PAC ID 8628327384, 202 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Corewell Health Pennock Hospital Hospital, Hastings, MI, CCN 231339
• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mjohnson2909928@direct.trinity-health.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ecs Western Michigan PC

  • Emergency Medicine Physician
  • Grand Rapids, MI
  • NPI 1992281000
  Medicare reassignment Care Compare group
• Iha Health Services Corporation

  dba IHA Canton Obstetrics and Gynecology

  • Obstetrics & Gynecology Physician
  • Canton, MI
  • NPI 1457408965
  Medicare reassignment
• Visionary Medical Services PC

  • Emergency Medicine Physician
  • Grand Rapids, MI
  • NPI 1538216569
  Medicare reassignment
• Iha Health Service Corporation

  dba Trinity Health IHA Medical Group OB/GYN Float

  • Obstetrics & Gynecology Physician
  • Ypsilanti, MI
  • NPI 1831053701
  NPD
• Iha Health Services Corporation

  dba Livingston Family Medicine Center

  • Family Medicine Physician
  • Brighton, MI
  • NPI 1790121309
  NPD
• Iha Health Services Corporation

  dba IHA Urgent Care-Domino's Farms

  • Urgent Care Clinic/Center
  • Ann Arbor, MI
  • NPI 1992937023
  NPD (past)

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

• Pennock Hospital

  dba Corewell Health Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Spectrum Health Hospitals

  dba Corewell Health Grand Rapids Hospital

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation

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

{
    "created_epoch": "1684800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1942992508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 E SHERMAN BLVD STE 100",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441863",
            "telephone_number": "231-672-3600",
            "fax_number": "231-672-3601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 E SHERMAN BLVD STE 100",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441863",
            "telephone_number": "231-672-3600",
            "fax_number": "231-672-3601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3457 Yellowstone Dr SW",
            "address_purpose": "LOCATION",
            "city": "Grandville",
            "state": "MI",
            "postal_code": "494181966",
            "country_code": "US",
            "telephone_number": "616-450-8569",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MACKENZIE",
        "middle_name": "SUE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-23",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5315236633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Johnson
• Harrison W Johnson, M.D.
• Kaitlyn Johnson, PHARMD
• Karimah K Johnson
• Kristina Johnson, LLMSW
• Marijo Johnson, RN
• Nancy Ann Johnson, RPH
• Sasha Nichole Johnson
• Sierra Johnson, LMSW
• Suzanna Johnson

• Physician Assistant in Muskegon, MI
• Providers in Muskegon, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.