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JOHNNY RAY VANDIVER PA
NPI 1629059126
Physician Assistant in Joint Base Lewis Mchord, WA

Active since November 10, 2005PECOS EnrolledAccepts Medicare Assignment
12233 24TH STREET, JOINT BASE LEWIS MCHORD, WA 98433(253) 477-5734 Get Directions Write a Review

NPPES record last updated: November 7, 2012. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Johnny Ray Vandiver Pa NPPES

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

JOHNNY RAY VANDIVER PA (NPI 1629059126) is an individual physician assistant in Joint Base Lewis Mchord, Washington and active in the NPI registry since November 2005. He is enrolled in Medicare PECOS and is a graduate of Other (1998).

NPPES Registry Identity

NPI1629059126
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameJOHNNY RAY VANDIVERCredential: PA
Location Address12233 24TH STREETJoint Base Lewis Mchord, WA 98433
Mailing AddressPo Box 33154Juneau, AK 99803-3154 · (907) 687-8224
Phone(253) 477-5734
Sole ProprietorNo
Medical School CMSOtherGraduated 1998
Enumeration DateNovember 10, 2005
Last NPPES UpdateNovember 7, 2012
✔ NPI 1629059126 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
12233 24TH STREET, Joint Base Lewis Mchord, WA 98433
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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

Johnny Ray Vandiver Pa 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 ID2264755792
PECOS Enrollment IDI20150108000380
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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 98433 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$88.29 typical visit price
range $57.27 – $172.80
Typical copayment $22.07 (range $14.31 – $43.20)
Most-billed visit code 99203
Established Patient
$71.29 typical visit price
range $18.56 – $141.11
Typical copayment $17.82 (range $4.64 – $35.27)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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 Johnny Vandiver's NPI number?

The NPI number for Johnny Vandiver is 1629059126. It was assigned to this individual provider in the NPPES registry on November 10, 2005.

Where is Johnny Vandiver located?

Johnny Vandiver practices at 12233 24th Street, Joint Base Lewis Mchord, WA 98433. The listed phone number is (253) 477-5734.

What is Johnny Vandiver's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Johnny Vandiver enrolled in Medicare?

Yes. Johnny Vandiver is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Johnny Vandiver was last updated on November 7, 2012. NPI Profile syncs with the weekly NPPES data releases published by CMS.