Individual ProviderScott JohnsonEmergency MedicineAllopathic & Osteopathic PhysiciansPractice AddressUniversity Hospital, L4, Stony Brook, NY 11794-0001(631) 444-2499PECOS EnrollmentBased on the most recent information from CMS, provider Scott 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 4 days ago.Profile DetailsProvider ID1720010572Provider TypeIndividualFull NameJohnson, ScottTitleDr.CredentialM.D.GenderMaleSole ProprietorNoEnumeration Date7/6/2006Last Updated7/8/2007Contact InformationPractice LocationPractice AddressUniversity Hospital, L4, Stony Brook, NY 11794-0001Phone(631) 444-2499FaxUnlisted FaxMailing LocationMailing AddressPO Box 1559, Stony Brook, NY 11790-0989Phone(631) 444-2499FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207P00000XPrimaryDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense203163New YorkProvider IdentifiersIDDescriptionIssuerID589001DescriptionOtherIssuerEMPIRE BC.BSNew YorkID02065561DescriptionMedicaidIssuerUnlistedNew YorkID57020250DescriptionOtherIssuerAETNANew York