NPIMap

Individual provider Active NPI

Kenneth Lee Johnson, M.D.

  • Otolaryngology Physician
  • Clayton, NC
National Provider Identifier
1124061783
Registry record updated May 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
2009-01364 Issued in NC
Practice address
34 Healthpark Way Ste 100D
Clayton, NC 27520-4497
Phone
(919) 585-8850
Fax
(919) 585-8869
NPI assigned
Jun 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 2009-01364 NC Primary

Addresses

Primary practice location

34 Healthpark Way Ste 100D
Clayton, NC 27520-4497

Mailing address

2000 Perimeter Park Dr Ste 200
Morrisville, NC 27560-8442

Other identifiers 1

IdentifierTypeStateIssuer
5912563MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kjohnson226786@direct.UNC.nchie.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090910000671 NC Practitioner - Otolaryngology 1456413053 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of North Carolina at Chapel Hill School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Unc Physicians Network LLCGroup PAC ID 5496940546, 985 clinicians
Carolina Physical Therapy Associates LLCGroup PAC ID 7012989684, 496 clinicians

Practice addresses (Care Compare)

34 Healthpark Way
Suite 100D
Clayton, NC 27520-4497
Phone (919) 585-8850

721 Tilghman Dr
Dunn, NC 28334-6066
Phone (910) 892-5635

Hospital & facility affiliations

  • Johnston Health Hospital, Smithfield, NC, CCN 340090
  • Rex Hospital Hospital, Raleigh, NC, CCN 340114

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
22939ALMDPharmacist
2009-01364NCMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Unc Physicians Network LLC CurrentSince Aug 1, 2017 Accepting new patients
DLP Wilson Physician Practices LLC Otolaryngology CurrentSince Mar 1, 2014 Accepting new patients
Eastern Carolina Pathology Associates PA Current Accepting new patients
Unc Physicians Network LLC Otolaryngology CurrentSince Aug 1, 2017 Accepting new patients
DLP Wilson Physician Practices LLC CurrentSince Mar 1, 2014 Accepting new patients
Unc Physicians Network LLC Current Accepting new patients
Randolph Health Systems, LLC Past Accepting new patients
University of Alabama at Birmingham Past Accepting new patients
University of Alabama at Birmingham Past Accepting new patients
Wilson Medical Center, Inc. Past Accepting new patients
Wedowee Hospital Past Accepting new patients
Alabama Orthopedic Spine & Sports Medicine Associates P C Past Accepting new patients

Locations

940 Martin Luther King Jr Blvd
Chapel Hill, NC 27514
Phone (919) 942-5123

34 Healthpark Way
Ste 100D
Clayton, NC 27520
Phone (919) 585-8850

1820 Veterans Pkwy
Ste 200
Clayton, NC 27520
Phone (919) 882-0880

2000 Perimeter Park Dr
Ste 200
Morrisville, NC 27560
Phone (800) 594-8624

2605 Forest Hills Rd SW
Ste A
Wilson, NC 27893
Phone (252) 243-0043

1700 Tarboro St W
Ste 100
Wilson, NC 27893
Phone (252) 399-5300

1700 Tarboro St W
Wilson, NC 27893
Phone (252) 399-5300

Interoperability endpoints

  • Direct secure messaging: kjohnson226786@direct.unc.nchie.net

Organizations & group practices 19

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.

View all 19

Hospital & facility affiliations 2

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": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1124061783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 PERIMETER PARK DR STE 200",
            "city": "MORRISVILLE",
            "state": "NC",
            "postal_code": "275608442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 HEALTHPARK WAY STE 100D",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275204497",
            "telephone_number": "919-585-8850",
            "fax_number": "919-585-8869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENNETH",
        "middle_name": "LEE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NC",
            "license": "2009-01364",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5912563",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kjohnson226786@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "34 Healthpark Way Ste 100D",
            "city": "Clayton",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275204497",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clayton, NC

Sources for this page

Verify at the official NPI Registry.