Individual provider Active NPI

Amy E Johnson, M.D.

  • Pediatrics Physician
  • Jackson, TN
National Provider Identifier
1073578456
Registry record updated Jun 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD63332 Issued in TN
Practice address
2863 Highway 45 Byp
Jackson, TN 38305-3618
Phone
(731) 422-0213
Fax
(731) 660-8369
NPI assigned
Apr 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 49323 CO
Pediatric Emergency Medicine (Emergency Medicine) Physician 207PP0204X DR.0049323 CO
Pediatrics Physician 208000000X INPROCESS TN
Pediatrics Physician 208000000X MD63332 TN Primary

Addresses

Primary practice location

2863 Highway 45 Byp
Jackson, TN 38305-3618

Mailing address

PO Box 400
Jackson, TN 38302-0400
Phone (731) 422-0213

Other names 1

  • Amy Johnson Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20230228001606 TN Practitioner - HospitalistPractitioner - Pediatric Medicine 8820140429 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0049323COMDPediatric Emergency Medicine (Emergency Medicine) Physician
MD63332TNMDPediatrics Physician
INPROCESSTNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Jude Children'S Research Hospital, Inc. Pediatrics CurrentSince Feb 13, 2023 Accepting new patients
Ut Lebonheur Pediatric Specialists, Inc. Pediatrics CurrentSince Nov 1, 2023 Accepting new patients
Paragon Emergency Physicians PC Past Accepting new patients
After Hours Pediatrics PC Pediatrics PastSince Jan 1, 2020 Accepting new patients

Locations

100 N Humphreys Blvd
Memphis, TN 38120
Phone (901) 747-1800

262 Danny Thomas Pl
Memphis, TN 38105
Phone (888) 226-4343

850 Poplar Ave
Bldg 2
Memphis, TN 38105
Phone (901) 287-5594

Interoperability endpoints

  • Direct secure messaging: ajohnson43645@mlh.direct-ci.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1073578456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 400",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383020400",
            "telephone_number": "731-422-0213",
            "fax_number": "731-422-5743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2863 HIGHWAY 45 BYP",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053618",
            "telephone_number": "731-422-0213",
            "fax_number": "731-660-8369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "AMY",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-19",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "49323",
            "primary": false
        },
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "CO",
            "license": "DR.0049323",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "INPROCESS",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "MD63332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "JOHNSON",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.