Individual provider Active NPI

Cheryl Karen Johnson, MD

  • Family Medicine Physician
  • Houston, TX
National Provider Identifier
1164419693
Registry record updated Nov 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
K2046 Issued in TX
Practice address
12121 Richmond Ave
Suite 226
Houston, TX 77082-2432
Phone
(281) 597-0991
Fax
(281) 597-0470
NPI assigned
Sep 30, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 18, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X K2046 TX Primary

Addresses

Primary practice location

12121 Richmond Ave
Suite 226
Houston, TX 77082-2432

Mailing address

12121 Richmond Ave
Suite 226
Houston, TX 77082-2432
Phone (281) 597-0991

Other identifiers 2

IdentifierTypeStateIssuer
7621494OtherTXAETNA
125500205MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040507001075 TX Practitioner - Family Practice 2365431129 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Toledo College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Richmond Avenue Family Practice Associates PAGroup PAC ID 4880743244, 7 clinicians

Practice addresses (Care Compare)

12245 Richmond Ave
Houston, TX 77082-2518
Phone (281) 558-6700

Hospital & facility affiliations

  • HCA Houston Healthcare West Hospital, Houston, TX, CCN 450644

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
K2046TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Richmond Avenue Family Practice Associates PA Family Medicine CurrentSince Jul 1, 2011 Accepting new patients
Galveston Physical Medicine PLLC CurrentSince Jul 1, 2015 Accepting new patients
United Chiropractic and Medical PLLC PastSince Jul 27, 2019 Accepting new patients
Southwest Doctors PA Past Accepting new patients
Duchon Chiropractic PastSince Jul 1, 2015 Accepting new patients
Suncoast Medical Group Inc Past Accepting new patients

Locations

2724 61st St
Ste 5
Galveston, TX 77551
Phone (409) 744-9355

12245 Richmond Ave
Houston, TX 77082
Phone (281) 558-5558

17080 Highway 3
Ste A
Webster, TX 77598
Phone (281) 557-5525

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CIFICA/Endpoint/CIFICA
  • FHIR API: https://api.platform.athenahealth.com/4066/brand/1/csg/1/fhir/r4

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447804800000",
    "number": "1164419693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12121 RICHMOND AVE",
            "address_2": "SUITE 226",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770822432",
            "telephone_number": "281-597-0991",
            "fax_number": "281-597-0470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12121 RICHMOND AVE",
            "address_2": "SUITE 226",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770822432",
            "telephone_number": "281-597-0991",
            "fax_number": "281-597-0470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CHERYL",
        "middle_name": "KAREN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-30",
        "last_updated": "2015-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K2046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7621494",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125500205",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.