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CRATER LAKE MEDICAL SOUTH
NPI 1447752035
Nurse Practitioner - Family in Shady Cove, OR

Active since February 28, 2018
21990 HIGHWAY 62, SHADY COVE, OR 97539(541) 878-2022(541) 878-1498 Get Directions Write a Review

NPPES record last updated: June 25, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jun 25, 2024, Feb 28, 2018 (2 updates tracked since 2018).

About Crater Lake Medical South NPPES

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

CRATER LAKE MEDICAL SOUTH (NPI 1447752035) is a healthcare organization registered as a family in Shady Cove, Oregon and active in the NPI registry since February 2018. The organization lists Laura Lynn Johnson, Nurse Practitioner, as its authorized official.

NPPES Registry Identity

NPI1447752035
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameLAURA L. JOHNSON, N.P., P.C.
Location Address21990 HIGHWAY 62Shady Cove, OR 97539-9717
Mailing AddressPo Box 508Shady Cove, OR 97539-0508 · (541) 878-2022 · Fax (541) 878-1498
Phone(541) 878-2022
Fax(541) 878-1498
Organization SubpartNo
Authorized OfficialLaura Lynn JohnsonNurse Practitioner · (541) 890-8826
Enumeration DateFebruary 28, 2018
Last NPPES UpdateJune 25, 20242 updates tracked since enumeration
NPPES CertifiedJune 25, 2024
✔ NPI 1447752035 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in OR · 201050002NP
21990 HIGHWAY 62, Shady Cove, OR 97539
Open in Google Maps ↗

Other Names 1

Doing Business AsCrater Lake Medical South

Other Identifiers 1

Medicaid500616623OR

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Crater Lake Medical South is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Crater Lake Medical South, which bills Medicare for the services this clinician delivers.

Clinician (1)

Laura Johnson, FNP
Nurse Practitioner
NPI 1023348430
1619 NW HAWTHORNE AVE STE 204
Grants Pass, OR 97526
(541) 916-8530
✔ PECOS✔ Accepts Medicare29 mi

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 Laura L. Johnson, N.P., P.C.'s NPI number?

The NPI number for Laura L. Johnson, N.P., P.C. is 1447752035. It was assigned to this organization in the NPPES registry on February 28, 2018. The provider is doing business as Crater Lake Medical South.

Where is Laura L. Johnson, N.P., P.C. located?

Laura L. Johnson, N.P., P.C. is located at 21990 Highway 62, Shady Cove, OR 97539. The listed phone number is (541) 878-2022.

What is Laura L. Johnson, N.P., P.C.'s specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Laura L. Johnson, N.P., P.C. enrolled in Medicare?

Yes. Laura L. Johnson, N.P., P.C. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Laura L. Johnson, N.P., P.C.?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Laura L. Johnson, N.P., P.C.. 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 Laura L. Johnson, N.P., P.C. accept?

Health plans from Moda Health Plan, Inc. list Laura L. Johnson, N.P., P.C. 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 Laura L. Johnson, N.P., P.C. was last updated on June 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.