Nicholas Bradford Johnson, MD is a medicare enrolled "Plastic Surgery" physician in Idaho Falls, Idaho. He went to St. Louis College Of Physicians And Surgeons and graduated in 2010 and has 16 years of diverse experience with area of expertise as Plastic And Reconstructive Surgery. He is a member of the group practice Steele Lake Specialty Pllc and his current practice location is
3200 Channing Way Ste 206, Idaho Falls, Idaho. You can reach out to his office (for appointments etc.) via phone at
(208) 529-2230.
Nicholas Bradford Johnson is licensed to practice in Idaho (license number M-14721) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1578850210.
Physician's Profile
| Full Name | Nicholas Bradford Johnson |
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| Gender | Male |
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| Speciality | Plastic And Reconstructive Surgery |
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| Experience | 16 Years |
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| Location | 3200 Channing Way Ste 206, Idaho Falls, Idaho |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Nicholas Bradford Johnson attended and graduated from St. Louis College Of Physicians And Surgeons in 2010
NPI Data:
- NPI Number: 1578850210
- Provider Enumeration Date: 07/01/2011
- Last Update Date: 03/25/2025
Medicare PECOS Information:
- PECOS PAC ID: 2860783404
- Enrollment ID: I20190927000381
Medical Identifiers
Medical identifiers for Nicholas Bradford Johnson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1578850210 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 208200000X | Plastic Surgery | 83999 (Georgia) | Secondary |
| 208200000X | Plastic Surgery | 01076429A (Indiana) | Secondary |
| 2086S0122X | Surgery - Plastic And Reconstructive Surgery | M-14721 (Idaho) | Secondary |
| 208200000X | Plastic Surgery | M-14721 (Idaho) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Steele Lake Specialty Pllc | 1153774567 | 13 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Nicholas Bradford Johnson allows following entities to bill medicare on his behalf.
| Entity Name | Steele Lake Specialty Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1215716998
PECOS PAC ID: 1153774567
Enrollment ID: O20240201000040 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Nicholas Bradford Johnson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Nicholas Bradford Johnson, MD
Po Box 277381,
Atlanta, GA 30384-7381
Ph: (208) 529-2230 | Nicholas Bradford Johnson, MD
3200 Channing Way Ste 206,
Idaho Falls, ID 83404-7546
Ph: (208) 529-2230 |
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