Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dallas Dominique Johnston, PA

Individual provider Physician Assistant · NPI 1386394898

Dallas Dominique Johnston, PA is a Physician Assistant in Grand Rapids, Michigan. Qualified in 2023, 3 years ago. Practices with Spectrum Health Primary Care Partners, a 2,303-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
3
Licensed in
MI
In the registry since
2022
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

100 Michigan St NE # MC019
Grand Rapids, MI 49503-2560
Phone: (616) 486-0310
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601011845 (MI)

Record details

NPI number1386394898
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedMarch 27, 2022
Last updated in NPPESOctober 9, 2023
Certification dateOctober 9, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Spectrum Health Primary Care Partners — 2303 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Grand Rapids