DR. JACQUELINE MARIE JOHNSON (D.O.) – Family Medicine Physician, NPI 1083814099
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,081 FAMILY PRACTICE in OR
Provider Addresses for DR. JACQUELINE MARIE JOHNSON (D.O.)
145 NE BROADWAY ST
MYRTLE CREEK, OR 974579039
Phone: (541) 677-7200
Fax: (541) 229-3309
Type: Location
2570, Northwest Edenbower Boulevard, Roseburg, Douglas County, Oregon, 97471, United States
STE 100
ROSEBURG, OR 97471
Phone: (541) 677-7200
Fax: (541) 229-3309
Type: Mailing
10201 SE MAIN ST STE 10
PORTLAND, OR 972162937
Phone: (503) 255-2186
Fax: (503) 255-2194
Type: Mailing
2570 NW EDENBOWER BLVD STE 100
ROSEBURG, OR 974716214
Phone: (541) 677-7200
Fax: (541) 229-3309
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 17 Open Payments records for all available years, with a total value of $344.
Total Amount is formed as General ($344) + Research ($0) + Ownership ($0) = $344.
Last reported payment date: 2024-11-05 • Largest payer in this snapshot: GlaxoSmithKline, LLC. ($119).
Total Amount
$344
General + Research + Ownership
Payments
17
Total payment records
General Amount
$344
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-05
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2013-07-03
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 |
|---|---|---|---|---|
| I20130703000184 | I | Family Practice | OR | 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 | 46 | 31 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 29 | 25 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 20 | 20 | $0 |
Insurance plans in this area (ZIP 97457)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | OR | |
| Internal Medicine, Pediatric Medicine, Endocrinology | OR | |
| Mental Health Counselor | OR | |
| Family Practice | OR | |
| Internal Medicine | OR | |
| Family Practice | OR | |
| Family Practice | OR | |
| Family Practice | OR | |
| Mental Health Counselor | OR | |
| Mental Health Counselor | OR |
Reviews
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