Individual provider Active NPI

Stephanie Deann Johnson, RN

  • Psychiatric/Mental Health Nurse Practitioner
  • Columbia, SC
National Provider Identifier
1104554302
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
27180 Issued in SC
Practice address
1 Richland Medical Park Dr Ste 100
Columbia, SC 29203-6834
Phone
(803) 434-6095
Fax
(803) 758-0120
NPI assigned
Aug 15, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 27180 SC Primary
General Practice Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163WG0000X 232093 SC

Addresses

Primary practice location

1 Richland Medical Park Dr Ste 100
Columbia, SC 29203-6834

Mailing address

300 E McBee Ave Ste 300
Greenville, SC 29601-2899
Phone (864) 522-8611

Other practice location 1

2720 Sunset Blvd
West Columbia, SC 29169-4810
Phone (803) 936-7377

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Other Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250109003852 SC Practitioner - Nurse Practitioner 9032647631 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health Medical Group-MidlandsGroup PAC ID 5991099707, 1,040 clinicians

Practice addresses (Care Compare)

1 Richland Medical Park Dr
Suite 100
Columbia, SC 29203-6834
Phone (803) 434-2020

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
232093SCMDGeneral Practice Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands Single Specialty CurrentSince Jan 12, 2025 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Jan 12, 2025 Accepting new patients

Locations

2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930

1 Richland Medical Park Dr
Ste 100
Columbia, SC 29203
Phone (803) 434-6095

Interoperability endpoints

  • Direct secure messaging: sjohnson831957@direct.ghs.myhfn.org

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1660521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1104554302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE STE 300",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012899",
            "telephone_number": "864-522-8611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 RICHLAND MEDICAL PARK DR STE 100",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036834",
            "telephone_number": "803-434-6095",
            "fax_number": "803-758-0120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2720 Sunset Blvd",
            "address_purpose": "LOCATION",
            "city": "West Columbia",
            "state": "SC",
            "postal_code": "291694810",
            "country_code": "US",
            "telephone_number": "803-936-7377",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "STEPHANIE",
        "middle_name": "DEANN",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-15",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "SC",
            "license": "27180",
            "primary": true
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, General Practice",
            "state": "SC",
            "license": "232093",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Other",
            "affiliation": "N",
            "endpointDescription": "Other",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Other",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Other",
            "address_1": "111 Saluda Springs Ct",
            "city": "Lexington",
            "state": "SC",
            "country_code": "US",
            "postal_code": "290726879",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.