Bruce Samuel Johnston, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

8390 Issued in SC

Practice address

901 W Greenwood St
Suite 9
Abbeville, SC 29620-5678

Phone

(864) 366-9681

Fax

(864) 366-5600

NPI assigned

Jul 26, 2005

Last updated

Mar 7, 2023By the provider in NPPES

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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pine Tree Family Practice, P. a.

  • Family Medicine Physician
  • Abbeville, SC
  • NPI 1174720577
  NPD (past) Authorized official

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1164422770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 W GREENWOOD ST",
            "address_2": "SUITE 9",
            "city": "ABBEVILLE",
            "state": "SC",
            "postal_code": "296205678",
            "telephone_number": "864-366-9681",
            "fax_number": "864-366-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W GREENWOOD ST",
            "address_2": "SUITE 9",
            "city": "ABBEVILLE",
            "state": "SC",
            "postal_code": "296205678",
            "telephone_number": "864-366-9681",
            "fax_number": "864-366-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "BRUCE",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-26",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "8390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC210",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080172913",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "576000003",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blake M Hodges, MD
• Melissa Glanton Holmes
• Mark Marion Horton, DMD
• Kam Houghtaling, RN
• Tracie Johnson, RN
• Joseph Frank Jones, LMSW
• K. W. Ballentine, MD, PA
• Julie Knox, PHARM.D
• Sandy Knox, R.N.
• Charles A. Kolb, MD

• Family Medicine Physician in Abbeville, SC
• Providers in Abbeville, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.