DEREK A JOHNSON (NPI# 1962746172) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962746172 |
| Entity Type | Individual |
| Full Name | DEREK A JOHNSON |
| Credential | PA-C |
| Practice Address |
1601 Clint Moore Rd Suite 195 Boca Raton FL 33487-2768 |
| Mailing Address |
2234 Colonial Blvd Attn: Payer Contracting & Relations Dept. Fort Myers FL 33907-1412 |
| Practice Telephone | 5619390700 |
| Practice Fax Number | 5619390723 |
| Mailing Telephone | 2399317342 |
| Mailing Fax Number | 2399317385 |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2016-12-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA9106805 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | FREEDOM | 1039541 | 01 |
| FL | RR MEDICARE | P01707166 | 01 |
| FL | AVMED | 398531 | 01 |
| FL | BCBS | IFS7Z | 01 |
| FL | OPTIMUM | 974430 | 01 |
| FL | AETNA | 4179920 | 01 |
| FL | CIGNA | 3011968 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770986556 | Derek Alan Johnson | Social Worker | 23772 West Rd # 195, Brownstown Twp, MI 48183-3050 | 2014-10-07 |
| 1043625999 | Derek Christopher Johnson | Psychiatry & Neurology | 255 S Routt St Ste 215, Lakewood, CO 80228-2271 | 2014-06-29 |
| 1104117571 | Derek Johnson | Acupuncturist | 7433 Montgomery Rd, Cincinnati, OH 45236-4160 | 2011-04-20 |
| 1164685913 | Derek Paul Johnson | Physical Therapist | 109 5th St Ne, Little Falls, MN 56345-2732 | 2008-07-02 |
| 1407046261 | Derek Sant Johnson | Orthopaedic Surgery | 729 Carol St, New Cumberland, PA 17070-1422 | 2007-07-27 |
| 1407876063 | Derek Johnson | Family Medicine | 350 John Muir Pkwy Ste 105, Brentwood, CA 94513-5183 | 2006-07-19 |
| 1285622183 | Derek K Johnson | Pediatrics | 3903a Fair Ridge Dr, Fairfax, VA 22033-2938 | 2005-10-13 |
| 1811544315 | Derek C Johnson | Pharmacist | 8330 Crawfordsville Rd, Indianapolis, IN 46234-1714 | 2019-08-20 |
| 1477043545 | Derek Charles Johnson | Pharmacist | 3600 Mallory Ln, Franklin, TN 37067-2900 | 2018-05-15 |
| 1013443563 | Derek W. Johnson | Counselor | 29 Bassett Ln, Hyannis, MA 02601-3813 | 2017-05-03 |
| Street Address |
1601 CLINT MOORE RD SUITE 195 |
| City | BOCA RATON |
| State | FL |
| Zip Code | 33487-2768 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275538944 | Jeremy S Breit | Internal Medicine | 1601 Clint Moore Rd, Suite 100, Boca Raton, FL 33487-2768 | 2005-06-17 |
| 1952876070 | Leslie Aston Wattkis | Nurse Practitioner | 1601 Clint Moore Rd, Boca Raton, FL 33487-2768 | 2018-10-04 |
| 1124578331 | Gabriel Johnson | Physician Assistant | 1601 Clint Moore Rd, Suite 155, Boca Raton, FL 33487-2768 | 2016-10-12 |
| 1912456963 | Internal Medicine Associates Snf LLC | Internal Medicine | 1601 Clint Moore Rd, Suite 200-2, Boca Raton, FL 33487-2768 | 2016-09-30 |
| 1710336797 | Docs On Call LLC | Internal Medicine | 1601 Clint Moore Rd, Suite 115 B, Boca Raton, FL 33487-2768 | 2016-06-09 |
| 1891156857 | Ashley Bowles | Podiatrist | 1601 Clint Moore Rd, Suite 130, Boca Raton, FL 33487-2768 | 2016-03-17 |
| 1912378829 | Gila R Weinstein Md LLC | Plastic Surgery | 1601 Clint Moore Rd, Suite 145, Boca Raton, FL 33487-2768 | 2015-10-19 |
| 1932578879 | 21st Century Oncology LLC | Pathology | 1601 Clint Moore Rd, Suite 180, Boca Raton, FL 33487-2768 | 2015-09-22 |
| 1770951055 | 21st Century Oncology LLC | Urology | 1601 Clint Moore Rd, Suite 195, Boca Raton, FL 33487-2768 | 2015-09-03 |
| 1962886408 | Lindsey Martin | Audiologist | 1601 Clint Moore Rd, Suite 105, Boca Raton, FL 33487-2768 | 2015-07-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386261741 | Kendall Hackenberg | Nurse Practitioner | 810 Nw 82nd Pl, Boca Raton, FL 33487 | 2020-07-01 |
| 1275187015 | Trusted Home Care Agency | Home Health | 1200 S. Rogers Circle, Suite #4, Boca Raton, FL 33487 | 2019-07-30 |
| 1972064475 | West Palm Beac Medical Supplies LLC | Durable Medical Equipment & Medical Supplies | 902 Clint Moore Road, Ste 144, Boca Raton, FL 33487 | 2019-03-27 |
| 1386153807 | Michael Christopher Angelillo | Internal Medicine | 1601 Clint Moore Rd Ste 115, Boca Raton, FL 33487 | 2017-09-27 |
| 1942729645 | Ronald Falk | Chiropractor | 6201 N Federal Hwy #5-6, Boca Raton, FL 33487 | 2017-09-13 |
| 1205292653 | Abigail Goodwin Sladek | Nurse Practitioner | 902 Clint Moore Rd # 227, Boca Raton, FL 33487 | 2016-01-14 |
| 1538539879 | Nancy Gonzalez | Dental Hygienist | 904 Clint Moore Rd, Boca Raton, FL 33487 | 2015-09-29 |
| 1083090138 | John Hooper Griscom | Internal Medicine | 3752 Mykonos Court, Boca Raton, FL 33487 | 2015-07-30 |
| 1144600321 | Hear Again LLC | Audiologist-Hearing Aid Fitter | 851 Broken Sound Pkwy Nw Ste 120, Boca Raton, FL 33487 | 2015-06-03 |
| 1457759193 | Element Lab Partners, LLC | Clinical Medical Laboratory | 1101 Holland Dr., Ste. 30, Boca Raton, FL 33487 | 2014-12-11 |
| Find all providers in zip 33487 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053941625 | Alexa Ely Maziuk | Physician Assistant | 246 E Camino Real, Boca Raton, FL 33432-6132 | 2020-01-22 |
| 1881238814 | Hannah Speer | Physician Assistant | 2427 Nw 49th Ln, Boca Raton, FL 33431-4337 | 2019-11-02 |
| 1396387122 | Martin Kent | Physician Assistant | 1599 Nw 9th Ave Ste 203, Boca Raton, FL 33486-1310 | 2019-10-14 |
| 1841841442 | Rachel Lauren Nebenzahl | Physician Assistant | 1601 Clint Moore Rd Ste 195, Boca Raton, FL 33487-5716 | 2019-09-25 |
| 1447800701 | Alisha Goldberg | Physician Assistant | 670 Glades Rd Ste 100, Boca Raton, FL 33431-6462 | 2019-09-18 |
| 1275189318 | Tatyana Gatina | Physician Assistant | 8505 Via D Oro, Boca Raton, FL 33433-2243 | 2019-08-14 |
| 1285192153 | Daniela Concha-alecchi | Physician Assistant | 7600 Camino Real Ste 102, Boca Raton, FL 33433-5514 | 2019-03-08 |
| 1144702168 | Sophia Theodorou | Physician Assistant | 7600 Camino Real, Boca Raton, FL 33433-5514 | 2018-09-06 |
| 1477048304 | Katherine Macbarron | Physician Assistant | 2200 Glades Rd Ste 305, Boca Raton, FL 33431-7348 | 2018-06-23 |
| 1437663028 | Jasmine Fay Senatus | Physician Assistant | 5333 Town Center Road, Suite 402, Boca Raton, FL 33486 | 2017-11-19 |
| Find all providers in BOCA RATON | ||||
| City | BOCA RATON |
| Zip Code | 33487 |
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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.