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

Nathan Johnson, PA-C

Individual provider Physician Assistant · NPI 1629701198

Nathan Johnson, PA-C is a Physician Assistant in Portage, Wisconsin. Qualified in 2024, 2 years ago. Practices with Divine Savior Healthcare Inc, a 132-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
2
Licensed in
WI
In the registry since
2022
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

2817 New Pinery Rd
Portage, WI 53901-9240
Phone: (608) 742-4131
Show map & directions

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

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (WI)

Record details

NPI number1629701198
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedJuly 2, 2022
Last updated in NPPESDecember 28, 2024
Certification dateDecember 28, 2024
Mailing address223860 Orchid Ln, Wausau, WI 54401-6629

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Divine Savior Healthcare Inc — 132 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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