Look up the most recent NPI and PECOS records

Cody Johnson

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

190 E Bannock St Fl 10, Boise, ID 83712-6241

PECOS Enrollment

Based on the most recent information from CMS, provider Cody 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 yesterday at 9:43 AM.

Profile Details

Provider ID
1184392011
Provider Type
Individual
Full Name
Johnson, Cody
Gender
Male

Sole Proprietor
No
Enumeration Date
9/3/2021
Last Updated
11/30/2022

Contact Information

Practice Location

190 E Bannock St Fl 10, Boise, ID 83712-6241

(208) 381-5500

Unlisted Fax

Mailing Location

190 E Bannock St, Boise, ID 83712-6241

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA-2399 Idaho
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Cody Johnson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Apreotesi, Angela

Elkin, Jessica E

Gorham, Amber Zoe

Cole-Riccardi, Michelle Denise

Murphy, Caroline

Lynn, Michael Brian

Nielson, David E

Davis, Brittney

Bowman, Dustin K

Hurty, Michelle R