Breena Marie Johnson, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

5601006233 Issued in MI

Practice address

416 Connable Ave
Petoskey, MI 49770-2212

Phone

(231) 330-4235

NPI assigned

Jan 4, 2011

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, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Center for Plastic Surgery of Northern MichiganGroup PAC ID 7113935933, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• The Center for Plastic Surgery of Northern Michigan

  • Specialist
  • Traverse City, MI
  • NPI 1356563654
  Medicare reassignment Care Compare group
• Munson Medical Group

  • Cardiovascular Disease Physician
  • Traverse City, MI
  • NPI 1821398322
  NPD (past)

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

{
    "created_epoch": "1294099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389312000000",
    "number": "1982908075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 RED OAK WAY",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 CONNABLE AVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702212",
            "telephone_number": "231-330-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BREENA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-04",
        "last_updated": "2014-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601006233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• JCS Optical Inc.
• Cheyenne Jepsen
• Melissa Ann Jibson, LLPC
• John J Degroot OD PC
• John M Cilluffo MD PLC
• Jonathon Johnson, CRNA
• Nancy D Johnson, CRNA
• Sarah Johnson, LMT
• Jonathan Dzingle Orthodontics PLLC
• Susan Marie Jones, CFNP

• Surgical Physician Assistant in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Surgical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2014; 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.