Individual provider Active NPI

Kem Jacqueline Johnson, MS, MED, CNS, LDN

  • Nutritionist
  • Baltimore, MD
National Provider Identifier
1083857312
Registry record updated Jun 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
NutritionistTaxonomy code 133N00000X
License
DX5837 Issued in MD
Practice address
1111 N Charles St
Baltimore, MD 21201-5505
Phone
(410) 837-2050
NPI assigned
Apr 16, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X SC1018 MD
Nutritionist 133N00000X DX5837 MD Primary

Addresses

Primary practice location

1111 N Charles St
Baltimore, MD 21201-5505

Mailing address

1111 N Charles St
Baltimore, MD 21201-5505
Phone (410) 837-2050

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230824000227 MD Practitioner - Registered Dietitian Or Nutrition Professional 9436512464 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chase Brexton Health Services IncGroup PAC ID 5395644835, 119 clinicians

Practice addresses (Care Compare)

1111 N Charles St
Baltimore, MD 21201-5505
Phone (410) 837-2050

500 Cadmus LN
Suite 203
Easton, MD 21601-4094
Phone (866) 260-0412

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist, Master of Education, Master of Science

State licenses

LicenseStateTypeSpecialty
SC1018MDMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Chase Brexton Health Services, Inc. CurrentSince Jul 31, 2023 Accepting new patients
Chase Brexton Health Services, Inc. CurrentSince Jul 31, 2023 Accepting new patients

Locations

1111 N Charles St
Baltimore, MD 21201
Phone (410) 486-5991

Organizations & group practices 2

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": "1239840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686096000000",
    "number": "1083857312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 N CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015505",
            "telephone_number": "410-837-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 N CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015505",
            "telephone_number": "410-837-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KEM",
        "middle_name": "JACQUELINE",
        "name_prefix": "Ms.",
        "credential": "MS, MED, CNS, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-16",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MD",
            "license": "SC1018",
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "MD",
            "license": "DX5837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.