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

Samuel Pennington Johnson, NP

Individual provider Acute Care Nurse Practitioner · NPI 1639969637

Samuel Pennington Johnson, NP is a Nurse Practitioner in Idaho Falls, Idaho. Qualified in 2024, 2 years ago. Practices with Intensive Care Consortium Inc, a 483-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
2
Licensed in
ID
In the registry since
2025
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

3100 Channing Way
Idaho Falls, ID 83404-7533
Phone: (801) 499-1889
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 4471358 (ID)

Record details

NPI number1639969637
Entity typeIndividual (Type 1)
GenderMale
Credentials NP
Sole proprietorNo
NPI enumeratedMay 12, 2025
Last updated in NPPESMay 12, 2025
Certification dateMay 12, 2025

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Intensive Care Consortium Inc — 483 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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