Timothy Samuel Johnson, MD
Individual provider Active NPI Family Medicine Physician · Atkins, AR
NPI 1023074119 · NPPES record last updated Feb 18, 2015
Key facts
- NPI
- 1023074119
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- E-3297 (AR)
- Practice address
- 1601 N Church St
Atkins, AR 72823-3234 - Phone
- (479) 641-2255
- Fax
- (479) 641-1889
- NPI assigned
- Apr 26, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040406000815 | AR | Practitioner - Family Practice | 3375536303 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-3297 | AR | MD | Family Medicine Physician |
Practice roles (3 of 6)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Marys Physician Services, LLC | Current |
Accepting new patients | |
| St Mary'S Physician Services LLC | Current |
Accepting new patients | |
| St Marys Physician Services, LLC | Past | Accepting new patients |
Locations
1601 N Church St
Atkins, AR 72823
Phone (479) 480-4066
101 Skyline Dr
Russellville, AR 72801
Phone (479) 968-2345
Networks
- MS PPO D-SNP
- MS PPO
- MS PPO C-SNP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | E-3297 | AR | Yes |
Addresses
Primary practice location
1601 N Church St
Atkins, AR 72823-3234
Mailing address
1601 N Church St
Atkins, AR 72823-3234
Phone (479) 641-2255
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 146729001 | Medicaid | AR |
Other providers in Atkins, AR
- Charles Henry
- Chris Howell Horan
- Catherine Leigh Horita
- Lauren Jackson
- Carroll Don Johnson
- Cinnamon Anne King
- McKinzie Nicole Lane
- Jade Dixon Laymon
- James Lusk
- Lyons Rehab Services, Inc
All providers in Atkins, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.