MATTIE RAYDON JOHNSON – Family Nurse Practitioner, NPI 1003537564

MATTIE RAYDON JOHNSON is a healthcare provider. based in Torrington, Wyoming. specializing in NURSE PRACTITIONER. They hold a License No. 44901 (WY). The NPI Number for MATTIE RAYDON JOHNSON is 1003537564

Main info

Female
4 Years Of Experience
Accepts Medicare Assignment
Name
MATTIE RAYDON JOHNSON
NPI
1003537564
Phone
Not provided
Address
625 ALBANY AVE
Enumeration Date
2 September 2022
Last Update Date
2 September 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3076353618
Graduation Year
2022 (4 years ago)
PAC ID
1658748173
Group Practice PAC ID
7315985942
Professional Enrollment ID
I20221111002264
Address ID
WY820072559CH2508XRDXX502
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience30
Completeness75
Years active:3State licenses:1Digital endpointsOther names

596 NURSE PRACTITIONER in WY

Provider Addresses for MATTIE RAYDON JOHNSON

  • 625 ALBANY AVE

    TORRINGTON, WY 822401530

    Phone:

    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 5 Open Payments records for all available years, with a total value of $113.

Total Amount is formed as General ($113) + Research ($0) + Ownership ($0) = $113.

Last reported payment date: 2024-08-21 • Largest payer in this snapshot: Alkermes, Inc. ($53).

Total Amount

$113

General + Research + Ownership

Payments

5

Total payment records

General Amount

$113

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-08-21

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: 2022-11-11

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
I20221111002264INurse PractitionerWYTBD

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
81003Automated urinalysis test2725$0
View full utilization report →

Insurance plans in this area (ZIP 82240)

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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: 7315985942View full group profile
NameSpecialtyState
-WY
-WY
Nurse PractitionerWY
Nurse PractitionerWY
Nurse PractitionerWY
Nurse PractitionerAL
Nurse PractitionerWY
Clinical Social WorkerWY
Clinical Social WorkerWY

Reviews

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Frequently asked questions

How is MATTIE RAYDON JOHNSON identified in CMS data?
CMS-hosted NPPES data lists MATTIE RAYDON JOHNSON with NPI 1003537564.
Does CMS list MATTIE RAYDON JOHNSON as active?
Yes — MATTIE RAYDON JOHNSON is active in the NPI listing used on this page.
What taxonomy line describes MATTIE RAYDON JOHNSON?
For research purposes, treat MATTIE RAYDON JOHNSON as Family Nurse Practitioner in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for MATTIE RAYDON JOHNSON?
MATTIE RAYDON JOHNSON's geographic hint is Torrington, Wyoming in our summary view.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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