SHAD CARL JOHNSON (NPI# 1114028354) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114028354 |
| Entity Type | Individual |
| Full Name | SHAD CARL JOHNSON |
| Credential | PA-C |
| Practice Address |
1151 Hospital Way Bldg A Pocatello ID 83201-2763 |
| Mailing Address |
1151 Hospital Way Bldg A P.o. Box 4788 Pocatello ID 83201-2763 |
| Practice Telephone | 2082326616 |
| Practice Fax Number | 2082326618 |
| Mailing Telephone | 2082326616 |
| Mailing Fax Number | 2082326618 |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA-629 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1151 HOSPITAL WAY BLDG A |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-2763 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295754265 | Southeast Idaho Gastroenterology,pllc | Internal Medicine | 1151 Hospital Way Bldg A, Pocatello, ID 83201-2763 | 2006-07-19 |
| 1073022778 | Kimberly Dolecheck Tverdy | Physician Assistant | 1151 Hospital Way Bldg A, Pocatello, ID 83201-5091 | 2017-09-25 |
| 1871016071 | Portneuf Asc, LLC | Clinic/Center | 1151 Hospital Way Bldg A, Pocatello, ID 83201-5091 | 2017-07-19 |
| 1710358007 | Matthew Gregson | Physician Assistant | 1151 Hospital Way Bldg A, Pocatello, ID 83201-5091 | 2015-10-12 |
| 1972525111 | Darryl Bruce Cook | Internal Medicine | 1151 Hospital Way Bldg A, Pocatello, ID 83201-2763 | 2006-07-24 |
| 1295757433 | Thomas Vance Davis | Internal Medicine | 1151 Hospital Way Bldg A, Pocatello, ID 83201-2763 | 2006-07-24 |
| 1992727143 | Charles Barclay Evans | Internal Medicine | 1151 Hospital Way Bldg A, Pocatello, ID 83201-2763 | 2006-07-24 |
| 1770502767 | Endoscopy Center, LLC | Clinic/Center | 1151 Hospital Way Bldg A, Pocatello, ID 83201-2763 | 2006-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720379597 | Lance W Mckay | Physician Assistant | 1151 Hospital Way, Bld D, Pocatello, ID 83201-5091 | 2011-04-27 |
| 1467602920 | Stephanie Theresa Hanson | Physician Assistant | 11460 N Philbin Rd, Pocatello, ID 83202-5306 | 2008-09-22 |
| 1780867457 | Southeast Idaho Gastroenterology, Pllc | Physician Assistant | 1151 Hospital Way Ste A, Pocatello, ID 83201-5091 | 2007-12-17 |
| 1174711758 | Rsm Pa Pllc | Physician Assistant | 1595 Bannock Hwy, Pocatello, ID 83204 | 2007-10-09 |
| 1760597462 | Karen Dickerson | Physician Assistant | 1352 E Center St, Pocatello, ID 83201-4734 | 2006-08-20 |
| 1265441547 | Nicole Manning | Physician Assistant | 475 Yellowstone Ave, Ste E, Pocatello, ID 83201-4528 | 2006-08-05 |
| 1124040506 | Michael John Doyle | Physician Assistant | 921 S 8th Ave Stop 8311, Pocatello, ID 83209-0002 | 2006-07-24 |
| 1417909862 | Cynthia Ann Bunde | Physician Assistant | 429 Washington Ave, Pocatello, ID 83201-4520 | 2006-05-16 |
| 1750342952 | Kebai Dawn Bills | Physician Assistant | 1777 E. Clark Suite # 210, Pocatello, ID 83201 | 2006-03-29 |
| 1073513065 | Helena M. B. Rizor | Physician Assistant | 1448 E Center St, Pocatello, ID 83201-4105 | 2005-07-30 |
| Find all providers in POCATELLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.