Individual provider Active NPI

Shannon Johnson, P.T.

  • Physical Therapist
  • Greer, SC
National Provider Identifier
1104931435
Registry record updated Feb 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5181 Issued in SC
Practice address
140 Executive Dr
Greer, SC 29651-1200
Phone
(864) 801-8706
Fax
(864) 848-7203
NPI assigned
Aug 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5181 SC Primary

Addresses

Primary practice location

140 Executive Dr
Greer, SC 29651-1200

Mailing address

140 Executive Dr
Greer, SC 29651-1200
Phone (864) 801-8706

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161026002134 SC Practitioner - Physical Therapist in Private Practice 7012295041 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Elite Integrated Therapy Centers LLCGroup PAC ID 3274552716, 51 clinicians

Practice addresses (Care Compare)

140 Executive Dr
Greer, SC 29651-1200
Phone (864) 801-8706

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5181SCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Elite Integrated Therapy Centers, LLC Physical Therapist CurrentSince Nov 1, 2021 Accepting new patients

Locations

2005 E Greenville St
Ste 119
Anderson, SC 29621
Phone (864) 512-7023

1007 Grove Rd
#A
Greenville, SC 29605

140 Executive Dr
Greer, SC 29651
Phone (864) 801-8706

Organizations & group practices 1

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": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1104931435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 EXECUTIVE DR",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296511200",
            "telephone_number": "864-801-8706",
            "fax_number": "864-848-7203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 EXECUTIVE DR",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296511200",
            "telephone_number": "864-801-8706",
            "fax_number": "864-848-7203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHANNON",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-19",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "5181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greer, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; 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.