MR. DOUGLAS W JOHNSON (PA-C) – Surgical Physician Assistant, NPI 1003816471
Surgical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
5,032 PHYSICIAN ASSISTANT in OH
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Provider Addresses for MR. DOUGLAS W JOHNSON (PA-C)
3995, Willow Run Drive, Mount Saint John, Beavercreek, Greene County, Ohio, 45430, United States
BEAVERCREEK, OH 454301552
Phone: (937) 429-7132
Fax: (937) 224-5307
Type: Mailing
1, Elizabeth Place, Edgemont, Dayton, Montgomery County, Ohio, 45417, United States
4TH FLOOR
DAYTON, OH 454081445
Phone: (937) 221-7001
Fax: (937) 224-5307
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $17.
Total Amount is formed as General ($17) + Research ($0) + Ownership ($0) = $17.
Last reported payment date: 2023-11-15 • Largest payer in this snapshot: Abbott Laboratories ($17).
Total Amount
$17
General + Research + Ownership
Payments
1
Total payment records
General Amount
$17
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-11-15
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Abbott Laboratories | $17 |
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: 2019-07-24
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 |
|---|---|---|---|---|
| I20190724003479 | I | Physician Assistant | OH | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 45430)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | OH | |
| Physician Assistant | OH | |
| Internal Medicine, Family Practice, Urology | OH | |
| O B S T E T R I C S/ G Y N E C O L O G Y | OH | |
| - | OH | |
| Internal Medicine, Pulmonary Disease, Critical Care (Intensivists) | OH | |
| O B S T E T R I C S/ G Y N E C O L O G Y | MN | |
| Physician Assistant | OH | |
| General Practice | OH | |
| Physician Assistant | OH |
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