Individual provider Active NPI

Sydney Swims Johnson

  • Speech-Language Pathologist
  • Memphis, TN
National Provider Identifier
1215509047
Registry record updated Aug 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
14287042 Issued in TN
Practice address
181 Marrakesh Cir
Memphis, TN 38103-5829
Phone
(731) 694-2263
NPI assigned
Jul 12, 2021
Last updated
Aug 2, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 14287042 TN Primary

Addresses

Primary practice location

181 Marrakesh Cir
Memphis, TN 38103-5829

Mailing address

1644 Brookside Dr
Germantown, TN 38138-2530
Phone (731) 694-2263

Other practice location 1

120 Windemere Cir
Jackson, TN 38305-3946
Phone (731) 694-2263

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211112001564 TN Practitioner - Qualified Speech Language Pathologist 2062801061 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Empowerme Rehabilitation LLCGroup PAC ID 2769723162, 423 clinicians
Aegis Group Practice LLCGroup PAC ID 5193036432, 399 clinicians

Practice addresses (Care Compare)

100 Carrick CT
Mt Juliet, TN 37122-8328
Phone (615) 380-4843

2180 Mangum Rd
Memphis, TN 38134-5810
Phone (901) 307-7741

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14287042TNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Aegis Group Practice LLC Speech-Language Pathologist Current Accepting new patients
Aegis Group Practice LLC Speech-Language Pathologist CurrentSince Jan 17, 2024 Accepting new patients
Ave Maria Home CurrentSince Oct 25, 2021 Accepting new patients
Aegis Group Practice LLC Speech-Language Pathologist CurrentSince Jan 17, 2024 Accepting new patients

Locations

4933 Old Greenwood Rd
Fort Smith, AR 72903

2805 Charles Bryan Rd
Bartlett, TN 38134
Phone (901) 386-3211

2180 Mangum Rd
Memphis, TN 38134
Phone (901) 307-7741

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722556800000",
    "number": "1215509047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1644 BROOKSIDE DR",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382530",
            "telephone_number": "731-694-2263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 MARRAKESH CIR",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381035829",
            "telephone_number": "731-694-2263"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 Windemere Cir",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "TN",
            "postal_code": "383053946",
            "country_code": "US",
            "telephone_number": "731-694-2263",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SYDNEY",
        "middle_name": "SWIMS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-12",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TN",
            "license": "14287042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.