NPIMap

Individual provider Active NPI

Jessica Lynn Johnson, DO

  • Family Medicine Physician
  • Seneca, SC
National Provider Identifier
1285059774
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36682 Issued in SC
Practice address
11082 N Radio Station Rd
Seneca, SC 29678
Phone
(864) 882-2314
Fax
(843) 882-3677
NPI assigned
Feb 20, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 36682 SC Primary

Addresses

Primary practice location

11082 N Radio Station Rd
Seneca, SC 29678

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8611

Other identifiers 1

IdentifierTypeStateIssuer
366820MedicaidSC

Other names 1

  • Jessica Lynn Clark Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20160614002328 SC Practitioner - Family Practice 5193946531 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Nova Southeastern College of Osteo Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11082 N Radio Station Rd
Seneca, SC 29678-1142
Phone (864) 882-2314

210 Freeman Farm Rd
Duncan, SC 29334-9398
Phone (864) 968-5123

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Spartanburg Medical Center CurrentSince Mar 22, 2016 Accepting new patients
Prisma Health University Medical Group CurrentSince Sep 2, 2023 Accepting new patients
Spartanburg Medical Center Current Accepting new patients
St Francis Physician Services Inc Family Medicine CurrentSince Jul 1, 2017 Accepting new patients
St Francis Physician Services Inc Family Medicine CurrentSince Jul 1, 2017 Accepting new patients
Prisma Health University Medical Group Family Medicine CurrentSince Sep 2, 2023 Accepting new patients
Spartanburg Medical Center Family Medicine CurrentSince Mar 22, 2016 Accepting new patients
St Francis Physician Services Inc Family Medicine Past Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

1200 Brookfield Blvd
Ste 400B
Greenville, SC 29607
Phone (864) 605-3721

304 Ashby Park Ln
Greenville, SC 29607
Phone (864) 286-9050

11082 N Radio Station Rd
Seneca, SC 29678
Phone (864) 882-2314

101 E Wood St
Ste 300
Spartanburg, SC 29303
Phone (864) 560-6554

853 N Church St
Ste 410A
Spartanburg, SC 29303
Phone (864) 560-6928

Interoperability endpoints

  • Direct secure messaging: jjohnson639073@direct.ghs.myhfn.org

Organizations & group practices 8

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

Hospital & facility affiliations 56

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 56

NPI Registry JSON

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

{
    "created_epoch": "1392854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1285059774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11082 N RADIO STATION RD",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "29678",
            "telephone_number": "864-882-2314",
            "fax_number": "843-882-3677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-20",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "36682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "366820",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "CLARK",
            "middle_name": "LYNN",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Seneca, SC

Sources for this page

Verify at the official NPI Registry.