Kimberly Johnson

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA055075 Issued in PA

Practice address

1850 E Park Ave Ste 103
Cema ER
State College, PA 16803-6706

Phone

(814) 231-7000

NPI assigned

Dec 11, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
• Direct secure messaging: upmchospitals@upmcdirect.com

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.

• Upmc Altoona

  • General Acute Care Hospital
  • Altoona, PA
  • NPI 1497831655
  Medicare reassignment NPD
• Upmc Bedford Memorial

  • Emergency Medicine Physician
  • Everett, PA
  • NPI 1184772113
  Medicare reassignment NPD
• Centre Emergency Medical Associates, PC.

  • Emergency Medicine Physician
  • State College, PA
  • NPI 1609891365
  Medicare reassignment
• Emergency Care Services of Pennsylvania, P.C.

  • Emergency Medicine Physician
  • Langhorne, PA
  • NPI 1114955010
  Medicare reassignment
• Emergency Care Services of Pennsylvania, P.C.

  • Emergency Medicine Physician
  • Wilkes Barre, PA
  • NPI 1235374927

  Physician Assistant

  NPD
• Upmc Altoona

  • Ambulatory Surgical Clinic/Center
  • Altoona, PA
  • NPI 1114926953
  NPD
• Upmc Bedford Memorial

  • Ambulatory Surgical Clinic/Center
  • Everett, PA
  • NPI 1942345467
  NPD
• Alexander Spring Emergency Physicians

  • Emergency Medicine Physician
  • Carlisle, PA
  • NPI 1386818029
  NPD (past)
• Liberty Emergency Physicians LLC

  • Emergency Medicine Physician
  • Easton, PA
  • NPI 1093932360
  NPD (past)

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

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1114100344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 GREGOR WAY",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 E PARK AVE STE 103",
            "address_2": "CEMA ER",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036706",
            "telephone_number": "814-231-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KIMBERLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-11",
        "last_updated": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA055075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "upmchospitals@upmcdirect.com",
            "affiliation": "Y",
            "affiliationName": "UPMC",
            "address_1": "600 Grant St",
            "address_2": "Floor 58",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152192702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• John Roberts Enterprises Inc
• John W. Leclair DMD
• Nicole Ardell Johndrow, LSW
• Amanda Johnson
• Jennifer Twichell Johnson, LCSW
• Matthew Ethan Johnson, PA-C
• McKenzie Rae Johnson, PA-C
• Bruce Dalton Johnston, R.PH.
• Christopher Roser Jones, M.D.
• Emily Jones, PHARMD

• Physician Assistant in State College, PA
• Providers in State College, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; 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.