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MRS. LISA MARIE JOHNSON P.A.
NPI 1295877785
Physician Assistant - Medical in Indialantic, FL

Active since February 13, 2007Opted out of Medicare · through Jan 1, 2027
150 5TH AVE STE A, INDIALANTIC, FL 32903(321) 254-6803(321) 254-6819 Get Directions Write a Review

NPPES record last updated: March 28, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mrs. Lisa Marie Johnson P.a. NPPES

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

MRS. LISA MARIE JOHNSON P.A. (NPI 1295877785) is an individual medical provider in Indialantic, Florida, licensed in Florida (PA9108416) and active in the NPI registry since February 2007. She has opted out of Medicare through January 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1295877785
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameMRS. LISA MARIE JOHNSONCredential: P.A.
Location Address150 5TH AVE STE AIndialantic, FL 32903-3154
Mailing Address150 5th Ave Ste AIndialantic, FL 32903-3154 · (321) 254-6803 · Fax (321) 254-6819
Phone(321) 254-6803
Fax(321) 254-6819
Sole ProprietorNo
Enumeration DateFebruary 13, 2007
Last NPPES UpdateMarch 28, 2022
NPPES CertifiedMarch 28, 2022
✔ NPI 1295877785 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
Licenses✔ Licensed in FL · PA9108416✔ Licensed in OK · 1338
150 5TH AVE STE A, Indialantic, FL 32903
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Other Identifiers 1

Medicaid200028010AOK

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Mrs. Lisa Marie Johnson P.a. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2025 through January 1, 2027.

Opt-Out Effective DateJanuary 1, 2025
Opt-Out In Effect ThroughJanuary 1, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

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 Lisa Johnson's NPI number?

The NPI number for Lisa Johnson is 1295877785. It was assigned to this individual provider in the NPPES registry on February 13, 2007.

Where is Lisa Johnson located?

Lisa Johnson practices at 150 5th Ave Ste A, Indialantic, FL 32903. The listed phone number is (321) 254-6803.

What is Lisa Johnson's specialty?

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

Is Lisa Johnson enrolled in Medicare?

No. Lisa Johnson has opted out of Medicare through January 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Lisa Johnson was last updated on March 28, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.