Individual provider Active NPI

Rene Lawrence Johnson, PA-C

  • Physician Assistant
  • Tacoma, WA
National Provider Identifier
1962284190
Registry record updated Sep 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1708 Yakima Ave
Tacoma, WA 98405-5307
Phone
(831) 334-7966
NPI assigned
Oct 23, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1708 Yakima Ave
Tacoma, WA 98405-5307

Mailing address

1802 Yakima Ave Ste 304
Tacoma, WA 98405-5305
Phone (253) 627-1244

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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

Enrollment IDStateProvider typePAC IDDetails
I20241118002190 WA Practitioner - Physician Assistant 3476087156 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

1717 S J St
Tacoma, WA 98405-4933
Phone (253) 426-6341

1802 Yakima Ave
Tacoma, WA 98405-5305
Phone (253) 627-1244

34503 9TH Ave S
Federal Way, WA 98003-8726

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group CurrentSince Oct 28, 2024 Accepting new patients
Franciscan Medical Group Physician Assistant Past Accepting new patients

Locations

34503 9th Ave S
Ste 130
Federal Way, WA 98003
Phone (253) 835-5340

1802 Yakima Ave
Ste 302
Tacoma, WA 98405
Phone (253) 591-6739

1802 Yakima Ave
Ste 304
Tacoma, WA 98405
Phone (253) 572-7101

1708 Yakima Ave
Tacoma, WA 98405
Phone (253) 272-2224

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1698019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726790400000",
    "number": "1962284190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 YAKIMA AVE STE 304",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984055305",
            "telephone_number": "253-627-1244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1708 YAKIMA AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984055307",
            "telephone_number": "831-334-7966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "RENE",
        "middle_name": "LAWRENCE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-23",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.