Look up the most recent NPI and PECOS records

Nathaniel Keith Johnson

Physical Medicine & Rehabilitation

Allopathic & Osteopathic Physicians

235 Wealthy St SE, Grand Rapids, MI 49503-5247

PECOS Enrollment

This provider is enrolled in PECOS as NATHANIEL JOHNSON.

Based on the most recent information from CMS, provider Nathaniel Keith Johnson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 8 days ago.

Profile Details

Provider ID
1043899925
Provider Type
Individual
Full Name
Johnson, Nathaniel Keith
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
4/6/2021
Last Updated
7/31/2025

Contact Information

Practice Location

235 Wealthy St SE, Grand Rapids, MI 49503-5247

(616) 840-8000

Unlisted Fax

Mailing Location

235 Wealthy St SE, Grand Rapids, MI 49503-5247

(616) 840-8000

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 208100000X Primary	Description Physical Medicine & Rehabilitation Allopathic & Osteopathic Physicians	License 4301513712 Michigan

Nathaniel Keith Johnson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Luyk, Clayton Joseph

Fromson, Andrea

White, Gregory Anthony

Campbell, Hannah

Polakowski, Nicholas James

Wang, Ralph

Olejniczak, Paul G

Rose, Alexander

Jeffers, Jacob Brayton

Deshpande, Aashish A