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

Shad Carl Johnson, PA-C

Individual provider Medical Physician Assistant · NPI 1114028354

Shad Carl Johnson, PA-C is a Physician Assistant in Pocatello, Idaho. Qualified in 2006, 20 years ago. Practices with Pocatello Health Services LLC, a 178-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Idaho.

Years since qualifying
20
Licensed in
ID
In the registry since
2006
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

1151 Hospital Way Bldg A
Pocatello, ID 83201-2763
Phone: (208) 232-6616
Fax: (208) 232-6618
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA-629 (ID)

Record details

NPI number1114028354
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 26, 2006
Last updated in NPPESJuly 8, 2007

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Group practice Pocatello Health Services Llc — 178 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Pocatello