LYNDON G JOHANSEN DPM PC
NPI 1093993453
Clinic/Center - Podiatric in Portland, OR
About Lyndon G Johansen Dpm Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LYNDON G JOHANSEN DPM PC (NPI 1093993453) is a healthcare organization registered as a podiatric in Portland, Oregon and active in the NPI registry since February 2008. The organization lists Lyndon George Johansen, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Lyndon G Johansen Dpm Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by March 31, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Lyndon G Johansen DPM PC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Lyndon G Johansen Dpm PC's NPI number?
The NPI number for Lyndon G Johansen Dpm PC is 1093993453. It was assigned to this organization in the NPPES registry on February 7, 2008.
Where is Lyndon G Johansen Dpm PC located?
Lyndon G Johansen Dpm PC is located at 12658 SE Stark St, Portland, OR 97233. The listed phone number is (503) 256-4018.
What is Lyndon G Johansen Dpm PC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Podiatric, with taxonomy code 261QP1100X.
Is Lyndon G Johansen Dpm PC enrolled in Medicare?
Yes. Lyndon G Johansen Dpm PC is registered in the Medicare PECOS enrollment system.
When is Lyndon G Johansen Dpm PC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Oregon, Clinic/Group Practice) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Lyndon G Johansen Dpm PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Podiatry) reassigns their Medicare billing to Lyndon G Johansen Dpm PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Lyndon G Johansen Dpm PC accept?
Health plans from BridgeSpan Health Company, Moda Health Plan, Inc., Providence Health Plan and Regence BlueCross BlueShield of Oregon list Lyndon G Johansen Dpm PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Lyndon G Johansen Dpm PC was last updated on October 5, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Lyndon G Johansen Dpm Pc · NPI 1093993453
Podiatric organization in Portland, Oregon. Organization record, active in the CMS NPPES registry since February 7, 2008.
## Identity
- **NPI:** 1093993453 (Entity type: Organization)
- **Enumerated:** February 7, 2008
- **Primary specialty:** Clinic/Center - Podiatric · taxonomy 261QP1100X
- **Organization subpart:** No
- **Authorized official:** Lyndon Johansen, OWNER
## Practice location
- **Address:** 12658 SE STARK ST, Portland, OR 97233-1058
- **Phone:** (503) 256-4018 · **Fax:** (503) 256-6298
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** March 31, 2027 (Non-DME Part B, Oregon, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Podiatry) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 5, 2011
- **Other identifiers:** Medicare NSC 4665150001
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Source: [NPI Profile](https://npiprofile.com/npi/1093993453) · Data from the CMS NPPES public registry.