NPIMap

Individual provider Active NPI

Jesse Wayne Johnson Jr., M.D.

  • Internal Medicine Physician
  • Lake Mary, FL
National Provider Identifier
1245344571
Registry record updated Mar 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME 49038 Issued in FL
Practice address
4106 W Lake Mary Blvd
Suite 100
Lake Mary, FL 32746-3315
Phone
(407) 333-2273
Fax
(407) 333-3939
NPI assigned
Aug 17, 2006
Last updated
Mar 30, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME 49038 FL Primary

Addresses

Primary practice location

4106 W Lake Mary Blvd
Suite 100
Lake Mary, FL 32746-3315

Mailing address

4106 W Lake Mary Blvd
Suite 100
Lake Mary, FL 32746-3315
Phone (407) 333-2273

Other identifiers 5

IdentifierTypeStateIssuer
AM199OtherFLMEDICARE PROVIDER TRANSACTION ACCESS NUMBER
0004104041OtherFLAETNA
04163OtherFLBLUE CROSS BLUE SHIELD
4308871OtherFLCIGNA
PTAN DN9084OtherFLMEDICARE RR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080910000530 FL Practitioner - Internal Medicine 5597757161 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Florida College of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ability Health Services, IncGroup PAC ID 4082523329, 1,249 clinicians
Ability Health Services and Rehabilitation LPGroup PAC ID 4981986288, shared by 2 NPIs, 1,260 clinicians
Heathrow Internal Medicine LLCGroup PAC ID 5294801536, 13 clinicians

Practice addresses (Care Compare)

1200 Lexington Green LN
Sanford, FL 32771-1013

4106 W Lake Mary Blvd
Suite 100
Lake Mary, FL 32746-3344
Phone (407) 333-2273

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.75 of 100Reported as individual
Quality
93.49
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 49038FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Heathrow Internal Medicine LLC Internal Medicine CurrentSince Mar 1, 2008 Accepting new patients

Locations

4106 W Lake Mary Blvd
Ste 100
Lake Mary, FL 32746
Phone (407) 333-2273

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Interoperability endpoints

  • Direct secure messaging: jesse.johnson@hca4.eclinicaldirectplus.com

Organizations & group practices 1

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.

Hospital & facility affiliations 12

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": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427673600000",
    "number": "1245344571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4106 W LAKE MARY BLVD",
            "address_2": "SUITE 100",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463315",
            "telephone_number": "407-333-2273",
            "fax_number": "407-333-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4106 W LAKE MARY BLVD",
            "address_2": "SUITE 100",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463315",
            "telephone_number": "407-333-2273",
            "fax_number": "407-333-3939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JESSE",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2015-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME 49038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER TRANSACTION ACCESS NUMBER",
            "identifier": "AM199",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0004104041",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "04163",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "4308871",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "PTAN DN9084",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

Verify at the official NPI Registry.