Kevin Michael Johnson Sr.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Practice address

28 E Susquehanna Ave Ste 101&102
Towson, MD 21286-5218

Phone

(443) 685-8565

NPI assigned

Dec 23, 2020

Last updated

Dec 23, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Gemini Treatment Center, LLC

  • Clinic/Center
  • Baltimore, MD
  • NPI 1023737012
  NPD Authorized official
• Gemini Treatment Center, LLC

  • Addiction Medicine (Family Medicine) Physician
  • Baltimore, MD
  • NPI 1104522424
  NPD Authorized official
• Real Life Changes, LLC

  • Community/Behavioral Health Agency
  • Towson, MD
  • NPI 1548846223
  NPD Authorized official

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

{
    "created_epoch": "1608681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608681600000",
    "number": "1285221333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 E SUSQUEHANNA AVE STE 101&102",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212865218",
            "telephone_number": "443-685-8565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 E SUSQUEHANNA AVE STE 101&102",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212865218",
            "telephone_number": "443-685-8565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KEVIN",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-23",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NA",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kjohnsonsr@reallifechanges.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "28 E Susquehanna Ave Ste 101&102",
            "city": "Towson",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212865218",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Andrew Johnson
• Angelina Johnson
• Imena Monet Johnson, PSYD
• Jenai Johnson
• Kendall Johnson
• Kyanna Johnson
• Lauren Johnson
• Mikenzie Johnson
• Monee Johnson
• Morgan Johnson

• Community/Behavioral Health Agency in Towson, MD
• Providers in Towson, MD by specialty
• Community/Behavioral Health Agency in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.