Individual ProviderConnor JohnsonPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address190 E Bannock St, Boise, ID 83712-6241(801) 884-7614PECOS EnrollmentBased on the most recent information from CMS, provider Connor Johnson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1275401523Provider TypeIndividualFull NameJohnson, ConnorCredentialPAGenderMaleSole ProprietorNoEnumeration Date10/28/2025Last Updated2/11/2026Contact InformationPractice LocationPractice Address190 E Bannock St, Boise, ID 83712-6241Phone(801) 884-7614FaxUnlisted FaxMailing LocationMailing Address190 E Bannock St, Boise, ID 83712-6241PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense2571593Idaho