Samantha Jo Johnson

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

9200 Issued in KY

Practice address

1938 Lyda Ave
Bowling Green, KY 42104-3326

Phone

(270) 843-5600

NPI assigned

Apr 17, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1334620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474502400000",
    "number": "1083971956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1938 LYDA AVE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421043326",
            "telephone_number": "270-843-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1938 LYDA AVE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421043326",
            "telephone_number": "270-843-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SAMANTHA",
        "middle_name": "JO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-17",
        "last_updated": "2016-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "9200",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "KY",
            "license": "9200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michaela Dawn Johnson, APRN
• Nathan Layne Johnson
• Nicholas Johnson, LCSW
• Rhonda G. Johnson, LCSW
• Richard Matthew Johnson, SERVICE COORDINATOR
• Sheridan Hope Johnson, MS CCC SLP
• Tori Johnson
• Twyla Johnson, APRN
• Veronica Mae Johnson, LPCC
• Linda Johnston

• Endodontics in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Endodontics in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2016; 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.