Edward Wallace Johnson III, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

338347 Issued in LA

Practice address

2703 Beene Blvd
Bossier City, LA 71111-5491

Phone

(318) 681-4515

Fax

(318) 681-4514

NPI assigned

Jun 17, 2013

Last updated

Oct 23, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TX, LA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Family Practice

Education

Louisiana State University School of Medicine in Shreveport, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christus Homecare Shreveport-Bossier Home health agency, Shreveport, LA, CCN 197074
• Christus Shreveport-Bossier Health System Hospital, Shreveport, LA, CCN 190041

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ejohnson135026@christushealth.direct-ci.net

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.

• Christus Trinity Clinic Texas

  dba Christus Trinity Clinic

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225

  LA

  Medicare reassignment Care Compare group NPD
• Mother Frances Hospital Jacksonville

  dba CHRISTUS Mother Frances Hospital - Jacksonville

  • Critical Access Hospital
  • Jacksonville, TX
  • NPI 1952306672
  Medicare reassignment NPD
• Mother Frances Hospital Regional Health Care Center

  dba Christus Mother Frances Hospital Tyler

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1679578439
  Medicare reassignment NPD
• Christus Trinity Clinic Texas

  dba Christus Trinity Clinic

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD

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

• Christus Health Northern Louisiana

  dba Christus Shreveport-Bossier Health System

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1417950106
  Care Compare affiliation
• LHCG Cviii, LLC

  dba CHRISTUS Homecare Shreveport-Bossier

  • Home Health Agency
  • Shreveport, LA
  • NPI 1780105908
  Care Compare affiliation

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

{
    "created_epoch": "1371427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1285073890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846098",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752846098",
            "telephone_number": "903-324-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2703 BEENE BLVD",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711115491",
            "telephone_number": "318-681-4515",
            "fax_number": "318-681-4514"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1505 State Highway 19 S",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "TX",
            "postal_code": "757518950",
            "country_code": "US",
            "telephone_number": "903-675-1725",
            "fax_number": "903-675-4790",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7045 Youree Dr",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711055108",
            "country_code": "US",
            "telephone_number": "318-681-6890",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2151 Airline Dr Ste 700",
            "address_purpose": "LOCATION",
            "city": "Bossier City",
            "state": "LA",
            "postal_code": "711113398",
            "country_code": "US",
            "telephone_number": "318-550-2176",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9300 Mansfield Rd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711183137",
            "country_code": "US",
            "telephone_number": "318-681-6795",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "EDWARD",
        "middle_name": "WALLACE",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-17",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "23591",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "338347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "364829701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-029",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8GF799",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P01754632",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John M Brady MD and Willis-Knighton Medical Center
• Ali N Johnson, PODOLOGIST
• Anthony Johnson
• Brookelyn Johnson
• Dbreona Johnson
• Glenda Johnson, MD
• Harriet Johnson
• Karen Johnson, LPC
• Lawrence W Johnson, M.D.
• Marcia Johnson, SPECIALIST

• Family Medicine Physician in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; 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.