Active NPI
Kadeem David Johnson
- Skilled Nursing Facility
- Wallingford, CT
National Provider Identifier
1194286005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Practice address
- 35 Mark Drive
Wallingford, CT 06492 - Phone
- (203) 265-0981
- NPI assigned
- Mar 26, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
35 Mark Drive
Wallingford, CT 06492
Mailing address
2 Park PL Apt 18E
Hartford, CT 06106-5016
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688947200000",
"number": "1194286005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 PARK PL APT 18E",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061065016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35 MARK DRIVE",
"city": "WALLINGFORD",
"state": "CT",
"postal_code": "06492",
"telephone_number": "203-265-0981"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KADEEM",
"middle_name": "DAVID",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-03-26",
"last_updated": "2023-07-10",
"certification_date": "2023-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wallingford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.