| Dr Jacqueline Marie Johnson, DO | |
|
145 Ne Broadway St, Myrtle Creek, OR 97457-9039 | |
| (541) 677-7200 | |
| (541) 229-3309 |
| Full Name | Dr Jacqueline Marie Johnson |
|---|---|
| Gender | Female |
| Speciality | Family Practice |
| Experience | 20 Years |
| Location | 145 Ne Broadway St, Myrtle Creek, Oregon |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083814099 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | O-0482 (Idaho) | Secondary |
| 207Q00000X | Family Medicine | DO161555 (Oregon) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Amedisys Home Health Care | Roseburg, OR | Home health agency |
| Amedisys Hospice Care | Roseburg, OR | Hospice |
| Mercy Medical Center | Roseburg, OR | Hospital |
| Asante Three Rivers Medical Center | Grants pass, OR | Hospital |
| Rose Haven Nursing Center | Roseburg, OR | Nursing home |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Centennial Medical Group East Llc | 9234397878 | 65 |
| Evergreen Family Medicine Pc | 3870485139 | 56 |
| Entity Name | Centennial Medical Group East Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1134436637 PECOS PAC ID: 9234397878 Enrollment ID: O20120228000510 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Jacqueline Marie Johnson, DO 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214 Ph: (541) 677-7200 | Dr Jacqueline Marie Johnson, DO 145 Ne Broadway St, Myrtle Creek, OR 97457-9039 Ph: (541) 677-7200 |
Mark Michael Herscher, D.O. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 145 Ne Broadway, Myrtle Creek, OR 97457 Phone: 541-863-3146 Fax: 541-863-3226 | |
Tom Lin, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 145 Ne Broadway St, Myrtle Creek, OR 97457 Phone: 541-677-7200 Fax: 541-229-3309 |