Kyle S Johnson, MD
Individual provider Active NPI Family Medicine Physician · Tuscaloosa, AL
NPI 1124609664 · NPPES record last updated Jul 16, 2024
Key facts
- NPI
- 1124609664
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD49123 (AL)
- Practice address
- 850 Peter Bryce Blvd
Tuscaloosa, AL 35401-7457 - Phone
- (205) 348-1770
- NPI assigned
- Apr 16, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 13
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Texas a & M University System, HSC, College of Medicine, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Whatley Health Services Inc
Capstone Health Services Foundation PC
Practice addresses (Care Compare)
2731 ML King Jr Blvd
Tuscaloosa, AL 35401-5235
Phone (205) 758-6647
850 Peter Bryce Blvd
Tuscaloosa, AL 35401-7457
Phone (205) 348-1770
Hospital & facility affiliations
- DCH Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240722003765 | AL | Practitioner - Family Practice | 0244639326 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD49123 | AL | MD | Family Medicine Physician |
| BP10074829 | TX | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Capstone Health Services Foundation PC | Family Medicine | Current |
Accepting new patients |
| Capstone Health Services Foundation PC | Current |
Accepting new patients | |
| Whatley Health Services, Inc. | Current |
Accepting new patients | |
| Whatley Health Services Inc | Current |
Accepting new patients | |
| The DCH Healthcare Authority | Past | Accepting new patients |
Locations
6205 Jemison Ln
Northport, AL 35476
Phone (205) 348-6122
2731 Ml King Jr Blvd
Tuscaloosa, AL 35401
Phone (205) 349-3250
850 Peter Bryce Blvd
Tuscaloosa, AL 35401
Interoperability endpoints
- kyle.johnson.p1@direct.umc.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | BP10074829 | TX | |
| Family Medicine Physician | 207Q00000X | MD49123 | AL | Yes |
Addresses
Primary practice location
850 Peter Bryce Blvd
Tuscaloosa, AL 35401-7457
Mailing address
850 Peter Bryce Blvd
Tuscaloosa, AL 35401-7457
Phone (205) 348-1770
Other providers in Tuscaloosa, AL
- Ianswer Johnson
- Jacquelyne Johnson
- Jamie Devon Johnson
- Keniece Johnson
- Kloi E Johnson
- Linda Black Johnson
- Sundra Renee Johnson
- Susie Marie Johnson
- Timothy Van Johnson
- Tondela Johnson
All providers in Tuscaloosa, AL · Family Medicine Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.