MRS. JACQUELINE S JOHANSON (P.A.-C) – Physician Assistant, NPI 1952304982
Physician Assistant
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
6,066 PHYSICIAN ASSISTANT in MI
Loading map...
Provider Addresses for MRS. JACQUELINE S JOHANSON (P.A.-C)
Michigan Street Northeast, Grand Rapids, Kent County, Michigan, 49506, United States
GRAND RAPIDS, MI 495031709
Phone: (404) 355-3161
Fax: (404) 355-1353
Type: Location
100 MICHIGAN ST NE MC 845
GRAND RAPIDS, MI 495032560
Phone:
Type: Mailing
230 Michigan St NE Ste 230
Grand Rapids, MI 495031709
Phone: (404) 355-3161
Fax: (404) 355-1353
Type: Location
310 LAFAYETTE AVE SE STE 410
GRAND RAPIDS, MI 495034693
Phone: (616) 685-8200
Fax: (616) 685-8202
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $124.
Total Amount is formed as General ($124) + Research ($0) + Ownership ($0) = $124.
Last reported payment date: 2023-05-11 • Largest payer in this snapshot: ViiV Healthcare Company ($124).
Total Amount
$124
General + Research + Ownership
Payments
1
Total payment records
General Amount
$124
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-05-11
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ViiV Healthcare Company | $124 |
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: 2018-01-03
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20050513000603 | I | Physician Assistant | GA | TBD |
| I20180103002074 | I | Physician Assistant | MI | 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 |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 20 | 11 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 20 | 11 | $0 |
Insurance plans in this area (ZIP 49503)
Loading plans...
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MI | |
| - | MI | |
| - | MI | |
| N E U R O L O G Y | MI | |
| Physician Assistant | MI | |
| - | MI | |
| - | MI | |
| Physician Assistant | MI | |
| Nurse Practitioner | MI | |
| - | MI |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.