SHAD CARL JOHNSON PA-C
NPI 1114028354
Physician Assistant - Medical in Pocatello, ID

Q: What is Shad Johnson's NPI number?

The NPI number for Shad Johnson is 1114028354. It was assigned to this individual provider in the NPPES registry on September 26, 2006.

Q: What is Shad Johnson's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Shad Johnson was last updated on July 8, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since September 26, 2006PECOS EnrolledAccepts Medicare Assignment

1151 HOSPITAL WAY BLDG A, POCATELLO, ID 83201(208) 232-6616(208) 232-6618 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Shad Carl Johnson Pa-c NPPES

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

SHAD CARL JOHNSON PA-C (NPI 1114028354) is an individual medical provider in Pocatello, Idaho, licensed in Idaho (PA-629) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS, is affiliated with Portneuf Medical Center, and is a graduate of Other (2006).

NPPES Registry Identity

NPI1114028354

Entity TypeIndividualMale

Primary Taxonomy363AM0700X

Provider Legal NameSHAD CARL JOHNSONCredential: PA-C

Location Address1151 HOSPITAL WAY BLDG APocatello, ID 83201-2763

Mailing Address1151 Hospital Way Bldg A, P.o. Box 4788Pocatello, ID 83201-2763 · (208) 232-6616 · Fax (208) 232-6618

Phone(208) 232-6616

Fax(208) 232-6618

Sole ProprietorNo

Medical School CMSOtherGraduated 2006

Enumeration DateSeptember 26, 2006

Last NPPES UpdateJuly 8, 2007

✔ NPI 1114028354 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in ID · PA-629

1151 HOSPITAL WAY BLDG A, Pocatello, ID 83201

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., PacificSource Health Plans, Providence Health Plan and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Shad Carl Johnson Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2466555487

PECOS Enrollment IDI20070313000263

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.

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

180 services133 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

143 services126 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

40 services40 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

34 services34 patients

Telephone medical discussion with physician, 11-20 minutes 99442

This is a service where you have a phone conversation with your doctor for 11-20 minutes. It's used for discussing health concerns, reviewing test results, or managing ongoing conditions. It's a convenient way to receive medical advice without an in-person visit.

19 services14 patients

Hospital Affiliations CMS Care Compare 4

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Portneuf Medical Center

Acute Care Hospitals · Pocatello, ID

4/5 CMS rating

OwnershipProprietary

CMS Certification Number130028

Location777 Hospital WayPocatello, ID 83201 · Bannock County

Emergency services Birthing friendly

Power County Hospital District

Critical Access Hospitals · American Falls, ID

OwnershipGovernment - Hospital District or Authority

CMS Certification Number131304

Location510 Roosevelt StreetAmerican Falls, ID 83211 · Power County

Emergency services

Caribou Medical Center

Critical Access Hospitals · Soda Springs, ID

OwnershipGovernment - Local

CMS Certification Number131309

Location300 South 3rd WestSoda Springs, ID 83276 · Caribou County

Emergency services

Bingham Memorial Hospital

Critical Access Hospitals · Blackfoot, ID

OwnershipVoluntary non-profit - Private

CMS Certification Number131325

Location98 Poplar StreetBlackfoot, ID 83221 · Bingham County

Emergency services

Other Providers at the Same Location NPPES 8

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

DARRYL BRUCE COOK M.D.

Internal Medicine (Gastroenterology)