IDELLA JOHNSON PA-C
NPI 1073554523
Physician Assistant in Tazewell, TN

Active since June 08, 2006PECOS Enrolled
1610 TAZEWELL RD, SUITE 201, TAZEWELL, TN 37879(423) 626-8393(423) 626-8749 Get Directions Write a Review

NPPES record last updated: December 16, 2015. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Idella Johnson Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IDELLA JOHNSON PA-C (NPI 1073554523) is an individual physician assistant in Tazewell, Tennessee, licensed in Tennessee (670) and active in the NPI registry since June 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1073554523
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameIDELLA JOHNSONCredential: PA-C
Location Address1610 TAZEWELL RD, SUITE 201Tazewell, TN 37879-3600
Mailing Address1610 Tazewell Rd, Suite 201Tazewell, TN 37879-3600 · (423) 626-8393 · Fax (423) 626-8749
Fax(423) 626-8749
Sole ProprietorNo
Enumeration DateJune 8, 2006
Last NPPES UpdateDecember 16, 2015
NPI 1073554523 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License Licensed in TN · 670
Definition

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.

1610 TAZEWELL RD, Tazewell, TN 37879

Other Identifiers 5

Medicaid3669471TN
Medicare PIN3669471TN
Medicare PIN103I979327TN
Other4058153TN · Bcbs Of Tennessee
Medicare UPINP01257TN

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Idella Johnson Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37879 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$81.53 typical visit price
range $52.64 – $160.89
Typical copayment $20.38 (range $13.16 – $40.22)
Most-billed visit code 99203
Established Patient
$66.01 typical visit price
range $16.72 – $131.41
Typical copayment $16.50 (range $4.18 – $32.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Surgery
1610 TAZEWELL RD, SUITE 301
TAZEWELL, TN 37879
Nurse Practitioner (Family)
1610 TAZEWELL RD, SUITE 201
TAZEWELL, TN 37879
Surgery
1610 TAZEWELL RD, STE 301
TAZEWELL, TN 37879
Surgery
1610 TAZEWELL RD, STE 301
TAZEWELL, TN 37879
Surgery
1610 TAZEWELL RD, STE 301
TAZEWELL, TN 37879
Surgery
1610 TAZEWELL RD, STE 301
TAZEWELL, TN 37879
Internal Medicine
1610 TAZEWELL RD, SE 201
TAZEWELL, TN 37879
Obstetrics & Gynecology
1610 TAZEWELL RD, STE 202
TAZEWELL, TN 37879

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1073554523, enumerated as an "individual" on June 08, 2006.

The provider is located at 1610 TAZEWELL RD SUITE 201 TAZEWELL, TN 37879 and the phone number is (423) 626-8393.

Physician Assistant with taxonomy code 363A00000X.

The provider might be accepting Accepts: Medicare, Medicaid and Blue Cross Blue Shield. Please consult your insurance carrier or call the provider to verify.