Mrs Shallon Tennille Johnson, FNP-C is a medicare enrolled "Nurse Practitioner - Family" in North Jackson, Ohio. Her current practice location is
10850 Mahoning Ave, North Jackson, Ohio. You can reach out to her office (for appointments etc.) via phone at
(330) 331-4966.
Mrs Shallon Tennille Johnson is licensed to practice in Ohio (license number 0037086) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1104660273.
Provider's Profile
| Full Name | Mrs Shallon Tennille Johnson |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 10850 Mahoning Ave, North Jackson, Ohio |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1104660273
- Provider Enumeration Date: 06/22/2024
- Last Update Date: 08/27/2025
Medicare PECOS Information:
- PECOS PAC ID: 8628501582
- Enrollment ID: I20241030002570
Medical Identifiers
Medical identifiers for Mrs Shallon Tennille Johnson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1104660273 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LF0000X | Nurse Practitioner - Family | 0037086 (Ohio) | Primary |
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. Mrs Shallon Tennille Johnson allows following entities to bill medicare on her behalf.
| Entity Name | On Demand Immediate Care Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1629468061
PECOS PAC ID: 7315289121
Enrollment ID: O20190426001755 |
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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. Mrs Shallon Tennille 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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Mrs Shallon Tennille Johnson, FNP-C
10850 Mahoning Ave,
North Jackson, OH 44451-8705
Ph: (330) 331-4966 | Mrs Shallon Tennille Johnson, FNP-C
10850 Mahoning Ave,
North Jackson, OH 44451-8705
Ph: (330) 331-4966 |
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