MS. IVY M. JOHNSON (PA-C) – Surgical Physician Assistant, NPI 1962553628
Surgical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
10,570 PHYSICIAN ASSISTANT in CA
Provider Addresses for MS. IVY M. JOHNSON (PA-C)
1440 N Harbor Blvd
STE 100
Fullerton, CA 928354127
Phone: (714) 447-3144
Fax: (714) 447-1944
Type: Location
22 Corporate Plaza Dr
Newport Beach, CA 926607985
Phone: (949) 722-7038
Fax: (949) 630-4900
Type: Location
210, North Harbor Boulevard, Downtown Fullerton, Fullerton, Orange County, California, 92832, United States
FULLERTON, CA 928352626
Phone: (714) 446-5192
Fax: (714) 515-8360
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 5 Open Payments records for all available years, with a total value of $131.
Total Amount is formed as General ($131) + Research ($0) + Ownership ($0) = $131.
Last reported payment date: 2024-01-18 • Largest payer in this snapshot: Spineart USA Inc ($43).
Total Amount
$131
General + Research + Ownership
Payments
5
Total payment records
General Amount
$131
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-01-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Spineart USA Inc | $43 |
| Bioventus LLC | $42 |
| SI-BONE, INC. | $23 |
| Biocomposites Inc | $22 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-09-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040907001322 | I | Physician Assistant | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 180 | 118 | $0 |
| 22614 | Fusion of additional segment of spine | 39 | 12 | $0 |
| 22853 | Insertion of cage or mesh device to spine bone and disc space during spine fusion | 23 | 11 | $0 |
| J1040 | Injection, methylprednisolone acetate, 80 mg | 14 | 11 | $0 |
| 20552 | Injection of trigger points, 1-2 muscles | 13 | 12 | $0 |
Insurance plans in this area (ZIP 92835)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Orthopedic Surgery | CA | |
| Nurse Practitioner | CA | |
| Physician Assistant | CA | |
| Physician Assistant | CA |
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