Travis Johnson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

55502 Issued in KY

Practice address

1219 W Main St
West Liberty, KY 41472-2161

Phone

(606) 743-4808

Fax

(606) 743-4716

NPI assigned

Apr 27, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: travis.johnson.p1@direct.juniperhealth.nextgenshare.com

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.

• Juniper Health Inc

  • Federally Qualified Health Center (FQHC)
  • Beattyville, KY
  • NPI 1407818628

  KY

  Medicare reassignment NPD
• QPS LLC

  • Community/Retail Pharmacy
  • Sandy Hook, KY
  • NPI 1538901186
  NPD
• Juniper Health Inc

  • Federally Qualified Health Center (FQHC)
  • Jackson, KY
  • NPI 1467417691
  NPD (past)

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

{
    "created_epoch": "1524787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1013405778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 690",
            "city": "BEATTYVILLE",
            "state": "KY",
            "postal_code": "413110690",
            "telephone_number": "606-464-0151",
            "fax_number": "606-464-0152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1219 W MAIN ST",
            "city": "WEST LIBERTY",
            "state": "KY",
            "postal_code": "414722161",
            "telephone_number": "606-743-4808",
            "fax_number": "606-743-4716"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1484 Lakeside Dr",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "KY",
            "postal_code": "413396555",
            "country_code": "US",
            "telephone_number": "606-666-9950",
            "fax_number": "606-666-9136",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TRAVIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-27",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "55502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100747240",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles Holbrook
• Susan Howard
• Aaron Hutchinson
• Chassidy Ison, LPP
• Jeffrey S. Bailey, DMD, PSC
• Lisa Jones
• Juniper Health Inc
• Misty Dawn Keeton
• Melisa Kennedy
• Kentucky Institute for Eye Health & Surgery

• All providers in West Liberty, KY
• Pediatrics Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.