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Deactivated NPI 1063766939 Deactivated / Inactive NPI Female Practitioner

Cassandra J. Johnson , ANP-BC

Nurse Practitioner • Detroit, MI

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Cassandra Johnson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date October 31, 2012
NPI Deactivation Date May 23, 2019
Total Practice Duration ~7 Years of Practice (2012 – 2019)

Professional Overview & Biography Verified Profile Summary

Cassandra Johnson, ANP-BC was a registered Nurse Practitioner practicing in Detroit, MI. Throughout an active medical career spanning 7 years, Cassandra Johnson provided care at the practice location at 261 MACK AVE until profile deactivation on 2019-05-23.

Historical Medicare Part B clinical services included established patient outpatient office visit, subsequent hospital care with moderate levelof medical decision making, if using time, at least. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

261 Mack Ave
Room 840

Detroit, MI 482012417

Telephone 3137454600
Fax 3137451063
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Nurse Practitioner in Detroit, MI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 12.8 Yrs
State Avg: 10.8 Yrs
Regional Practice Density
195 Specialists

Practicing in Detroit, MI (3626 Statewide)

Telehealth Adoption Rate
10.3% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
79.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2018)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
16 13 $330.00 $64.87
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more
15 14 $450.00 $95.64

Medical Specialties & State Licenses

Nurse Practitioner Primary Specialty

NUCC Taxonomy Code: 363L00000X

State License MI 4704184415

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

10 Associated Practitioners
Dr. David Rustom , MD

Physical Medicine & Rehabilitation - Pain Medicine

NPI 1073877320

Doctor of Medicine (M.D.)

Dr. Derek Boyd , MD

Student in an Organized Health Care Education/Training Program

NPI 1174936959

Doctor of Medicine (M.D.)

Aevah Hebda

Occupational Therapist

NPI 1356163059
Felecia Marshall , PA

Physician Assistant

NPI 1619917556

Physician Assistant

Dr. Lourdes Alfonso , MD

Physical Medicine & Rehabilitation

NPI 1720025323

Doctor of Medicine (M.D.)

Michael Bush-Arnold

Physical Medicine & Rehabilitation

NPI 1740600675

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated May 23, 2019

Record deactivated on May 23, 2019

NPI Profile Active September 29, 2015

NPI status registered as active in NPPES database

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Updated Practice Location September 29, 2015

Registered at 261 MACK AVE, ROOM 840, DETROIT, MI 482012417 (Tel: 3137454600)

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Updated Business Mailing Address September 29, 2015

Registered at 1560 E MAPLE RD, SUITE 400-CREDENTIALING, TROY, MI 480831138 (Tel: 2485815974)

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Provider Name / Credentials Updated September 29, 2015

Recorded as CASSANDRA JOHNSON, ANP-BC

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Medical Taxonomy / Specialty Registered (Primary Specialty) September 29, 2015

Nurse Practitioner (License #4704184415 in MI)

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Initial NPI Registration & Enumeration October 31, 2012

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1063766939
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 31, 2012
Last Update: September 29, 2015
Deactivation Date: May 23, 2019

Mailing Address

1560 E Maple Rd, Suite 400-Credentialing

Troy, MI 480831138

Phone: 2485815974

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.