Johnie Ray Staton III, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05014558A Issued in IN

Practice address

2091 Ridgemere Way
Greenwood, IN 46143-9288

Phone

(317) 887-1600

NPI assigned

May 25, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Privia Medical Group Tennessee LLCGroup PAC ID 0547667552, 141 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: johnie.staton.1@25094.direct.athenahealth.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.

• Privia Medical Group Tennessee LLC

  • Family Medicine Physician
  • Nashville, TN
  • NPI 1376110858
  Medicare reassignment Care Compare group NPD
• Privia Medical Group Tennessee LLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Nashville, TN
  • NPI 1215694229
  NPD

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

{
    "created_epoch": "1653436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653436800000",
    "number": "1114665528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2091 RIDGEMERE WAY",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461439288",
            "telephone_number": "317-887-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2091 RIDGEMERE WAY",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461439288",
            "telephone_number": "317-887-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATON",
        "first_name": "JOHNIE",
        "middle_name": "RAY",
        "name_suffix": "III",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-25",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05014558A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Stahl, LCSW
• Cameron Ross Stahlhut, LMFT
• Amber Darlene Davis Staller
• Mariah Stansbury
• Morgan Stasik, RD
• Savannah Steenberger, RBT
• David I Steinberg, DO
• Ashley Steiner
• Donna Steinway, PT
• Kennedy Stenger, BCBA

• Physical Therapist in Greenwood, IN
• Providers in Greenwood, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; 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.