Individual provider Active NPI

Joel Johnson, FNP-C

  • Family Nurse Practitioner
  • Lithia, FL
National Provider Identifier
1992180582
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP9212395 Issued in FL
Practice address
6228 Kingbird Manor Dr
Lithia, FL 33547-5049
Phone
(813) 220-9975
NPI assigned
Jul 23, 2015
Last updated
Dec 4, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP9212395 FL Primary

Addresses

Primary practice location

6228 Kingbird Manor Dr
Lithia, FL 33547-5049

Mailing address

6228 Kingbird Manor Dr
Lithia, FL 33547-5049

Other identifiers 1

IdentifierTypeStateIssuer
ARNP9212395OtherFLMEDICARE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20151201000053 FL Practitioner - Nurse Practitioner 5597065367 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Care Hospitalists PLGroup PAC ID 5092753632, 66 clinicians

Practice addresses (Care Compare)

4315 Highland Park Blvd
Suite D
Lakeland, FL 33813-1639
Phone (863) 816-5884

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP9212395FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ashit K Vijapura MD PA CurrentSince Jun 14, 2023 Accepting new patients
Advanced Care Hospitalists PL CurrentSince Aug 15, 2015 Accepting new patients

Locations

4315 Highland Park Blvd
Ste A
Lakeland, FL 33813
Phone (813) 651-1085

4315 Highland Park Blvd
Ste D
Lakeland, FL 33813
Phone (863) 816-5884

802 W Dr Martin Luther King Jr Blvd
Ste D
Plant City, FL 33563
Phone (813) 707-9101

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1437609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1992180582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6228 KINGBIRD MANOR DR",
            "city": "LITHIA",
            "state": "FL",
            "postal_code": "335475049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6228 KINGBIRD MANOR DR",
            "city": "LITHIA",
            "state": "FL",
            "postal_code": "335475049",
            "telephone_number": "813-220-9975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JOEL",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-23",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9212395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LICENSE",
            "identifier": "ARNP9212395",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lithia, FL

Sources for this page

Verify at the official NPI Registry.