Physician Compare National (NPI:1215215009)

HEALTHCARE PROVIDER: AMANDA JOHNSON PMHNP-BC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1215215009
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9436370152
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20141022001772
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JOHNSON
	Individual professional last name
Provider First Name	AMANDA
	Individual professional first name
Provider Middle Name	F
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1604 HILLTOP W CTR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 215
	Group Practice or individual's line 2 address
City	VIRGINIA BEACH
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	234516196
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	490092
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SOUTHAMPTON MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	490007
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SENTARA NORFOLK GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y