Kelly Jackson Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA1637 Issued in KY

Practice address

510 Lincoln Dr
Herrin, IL 62948-6334

Phone

(618) 997-6800

Fax

(618) 997-1187

NPI assigned

Sep 20, 2011

Last updated

Feb 23, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Elizabeth Jackson Former name

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

94.29 of 100Reported as apm

Quality

87.32

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Baptist Health Medical Group Inc

  dba Dawson Springs Rural Health Clinic

  • Rural Health Clinic/Center
  • Dawson Springs, KY
  • NPI 1982178216
  Medicare reassignment NPD
• Baptist Health Medical Group Inc

  dba Richmond Rural Health Center

  • Rural Health Clinic/Center
  • Richmond, KY
  • NPI 1740758325
  NPD

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

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487808000000",
    "number": "1235412982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4787 ALBEN BARKLEY DR",
            "address_2": "SUITE 103",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420016789",
            "telephone_number": "270-442-9461",
            "fax_number": "270-441-0079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 LINCOLN DR",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629486334",
            "telephone_number": "618-997-6800",
            "fax_number": "618-997-1187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLY",
        "middle_name": "JACKSON",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-20",
        "last_updated": "2017-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA1637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "JACKSON",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeffrey Mark Jacobs, M.D.
• Mahmoud Jallad, DDS, MSD
• Rachael Nicole Janello, LPTA
• Javier Muniz, DO, LLC
• Angelina Johnson
• Melody Johnson, LPN
• Jared Jones
• Leslie Suzanne Jones, N.P. - C
• Mary Kalert, PTA
• Cyril Kamya, M.D

• Physician Assistant in Herrin, IL
• Providers in Herrin, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.