NPIMap

Individual provider Active NPI

Koryn Amanda Johnston, D.O.

  • Family Medicine Physician
  • Wellsboro, PA
National Provider Identifier
1003107442
Registry record updated Mar 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS017260 Issued in PA
Practice address
110 Plaza LN
Wellsboro, PA 16901-1773
Phone
(570) 724-4241
Fax
(570) 724-5510
NPI assigned
Apr 19, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS017260 PA Primary

Addresses

Primary practice location

110 Plaza LN
Wellsboro, PA 16901-1773

Mailing address

1 Guthrie SQ
Sayre, PA 18840-1625
Phone (570) 888-5858

Other identifiers 1

IdentifierTypeStateIssuer
03987359MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kjohnston20496@direct-guthrie.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141030001130 PA Practitioner - Family Practice 6507087889 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Mid West Medical College, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Guthrie Medical Group PCGroup PAC ID 6002728656, 795 clinicians
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Susquehanna Physician ServicesGroup PAC ID 2264336460, shared by 32 NPIs, 611 clinicians

Practice addresses (Care Compare)

1 Guthrie SQ
Sayre, PA 18840-1625
Phone (570) 888-5858

110 Plaza LN
Wellsboro, PA 16901-1773
Phone (570) 724-4241

2000 Westinghouse Dr
Cranberry Township, PA 16066-5238

275 Guthrie Dr
Troy, PA 16947-8115
Phone (570) 297-2121

285 Guthrie Dr
Troy, PA 16947-8115
Phone (570) 297-4104

416 S Main St
Mansfield, PA 16933-1510

One Guthrie SQ
Sayre, PA 18840-1625

One Guthrie Square
Sayre, PA 18840-1625

Hospital & facility affiliations

  • Guthrie Home Health Home health agency, Towanda, PA, CCN 397120
  • Upmc Home Healthcare Home health agency, Williamsport, PA, CCN 397006
  • Family Hospice Hospice, Williamsport, PA, CCN 391513
  • Robert Packer Hospital Hospital, Sayre, PA, CCN 390079
  • Troy Community Hospital Hospital, Troy, PA, CCN 391305
  • Upmc Wellsboro Hospital, Wellsboro, PA, CCN 391316
  • Corning Hospital Hospital, Corning, NY, CCN 330277
  • Geisinger Medical Center Hospital, Danville, PA, CCN 390006

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions15
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS017260PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Guthrie Medical Group, P.C. Family Medicine Current Accepting new patients
Guthrie Medical Group, P.C. Family Medicine CurrentSince Oct 22, 2014 Accepting new patients
Guthrie Medical Group PC Past Accepting new patients

Locations

1 Guthrie Sq
Sayre, PA 18840
Phone (570) 887-3106

110 Plaza Ln
Wellsboro, PA 16901
Phone (570) 724-4241

Networks

  • OH PPO
  • devoted network organization-598bd2d4-c652-473f-ba7a-132f674c8eb6

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 36

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 36

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614816000000",
    "number": "1003107442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-888-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 PLAZA LN",
            "city": "WELLSBORO",
            "state": "PA",
            "postal_code": "169011773",
            "telephone_number": "570-724-4241",
            "fax_number": "570-724-5510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "KORYN",
        "middle_name": "AMANDA",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-19",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS017260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03987359",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kjohnston20496@direct-guthrie.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "110 Plaza Ln",
            "city": "Wellsboro",
            "state": "PA",
            "country_code": "US",
            "postal_code": "169011773",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wellsboro, PA

Sources for this page

Verify at the official NPI Registry.