SAMANTHA VAN DYKE JOHNSON MD
NPI 1174330112
Student in an Organized Health Care Education/Training Program in Aurora, CO
About Samantha Van Dyke Johnson Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SAMANTHA VAN DYKE JOHNSON MD (NPI 1174330112) is an individual student in an organized health care education/training program in Aurora, Colorado, licensed in Colorado (TL.0010600) and active in the NPI registry since December 2024. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Samantha Van Dyke Johnson Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
AURORA, CO 80045
AURORA, CO 80045
AURORA, CO 80045
AURORA, CO 80045
AURORA, CO 80045
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 Samantha Johnson's NPI number?
The NPI number for Samantha Johnson is 1174330112. It was assigned to this individual provider in the NPPES registry on December 13, 2024.
Where is Samantha Johnson located?
Samantha Johnson practices at 13001 E 17th Pl, Aurora, CO 80045. The listed phone number is (575) 218-5936.
What is Samantha Johnson's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Samantha Johnson enrolled in Medicare?
Yes. Samantha Johnson is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Samantha Johnson was last updated on April 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months 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.
# Samantha Van Dyke Johnson, MD · NPI 1174330112
Student in an Organized Health Care Education/Training Program provider in Aurora, Colorado. Individual provider, active in the CMS NPPES registry since December 13, 2024.
## Identity
- **NPI:** 1174330112 (Entity type: Individual)
- **Enumerated:** December 13, 2024
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **State license:** TL.0010600 (Colorado)
- **Sole proprietor:** No
## Practice location
- **Address:** 13001 E 17TH PL, Aurora, CO 80045-2570
- **Phone:** (575) 218-5936
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** April 21, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1174330112) · Data from the CMS NPPES public registry.