HOLLY JOHNSON – Family Nurse Practitioner, NPI 1124475058

HOLLY JOHNSON is a healthcare provider. based in Escanaba, Michigan. specializing in NURSE PRACTITIONER. They hold a License No. 4704278219 (MI). The NPI Number for HOLLY JOHNSON is 1124475058

Main info

Female
10 Years Of Experience
Accepts Medicare Assignment
Name
HOLLY JOHNSON
NPI
1124475058
Phone
(906) 789-4414
Address
3409 LUDINGTON ST
Enumeration Date
20 May 2016
Last Update Date
27 June 2017

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
2016 (10 years ago)
PAC ID
2567759202
Group Practice PAC ID
5991604753
Professional Enrollment ID
I20160923002202
Address ID
MI498294212ES3409XSTXX300
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience39
Completeness75
Years active:10State licenses:1Digital endpointsOther names

8,105 NURSE PRACTITIONER in MI

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Provider Addresses for HOLLY JOHNSON

  • OSF Medical Office Building, 3409, Ludington Street, Escanaba, Delta County, Michigan, 49829, United States

    SUITE 100

    ESCANABA, MI 498294212

    Phone: (906) 789-4414

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 2 Open Payments records for all available years, with a total value of $54.

Total Amount is formed as General ($54) + Research ($0) + Ownership ($0) = $54.

Last reported payment date: 2024-10-14 • Largest payer in this snapshot: GlaxoSmithKline, LLC. ($35).

Total Amount

$54

General + Research + Ownership

Payments

2

Total payment records

General Amount

$54

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-14

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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: 2016-09-23

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20160923002202INurse PractitionerMITBD

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.

Verify on CMS Revalidation Lookup Tool

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 49829)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5991604753View full group profile
NameSpecialtyState
Certified Nurse Midwife (Cnm)MI
Pulmonary DiseaseMI
Medical Oncology, Internal MedicineWI
Nurse PractitionerMI
Family PracticeMI
Nurse PractitionerMI
Physician AssistantWI
-MI
Cardiac Electrophysiology, Cardiovascular Disease (Cardiology)WI
Cardiovascular Disease (Cardiology)WI

Reviews

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Frequently asked questions

Can I verify HOLLY JOHNSON with an NPI only?
You can start verification with NPI 1124475058 for HOLLY JOHNSON, then check state licensing separately.
Is HOLLY JOHNSON listed as active for patients and plans?
The listing shows HOLLY JOHNSON as active in the NPI system.
What is HOLLY JOHNSON's specialty?
The listing groups HOLLY JOHNSON with Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What address line appears for HOLLY JOHNSON?
HOLLY JOHNSON's geographic hint is Escanaba, Michigan in our summary view.
Is the information about HOLLY JOHNSON up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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