NPIMap

Individual provider Active NPI

Larry C Johnson, MD

  • Family Medicine Physician
  • Owenton, KY
National Provider Identifier
1285653618
Registry record updated Dec 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35775 Issued in KY
Practice address
120 Progress Way
Owenton, KY 40359-6032
Phone
(844) 655-6100
Fax
(502) 484-2102
NPI assigned
Jul 18, 2006
Last updated
Dec 5, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 35775 KY
Family Medicine Physician 207Q00000X 35775 KY Primary

Addresses

Primary practice location

120 Progress Way
Owenton, KY 40359-6032

Mailing address

1401 Madison Ave
Covington, KY 41011-3313
Phone (859) 655-6100

Other identifiers 1

IdentifierTypeStateIssuer
64051022MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20041115001133 KY Practitioner - Family PracticePractitioner - Emergency Medicine 1850384264 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
University of Louisville School of Medicine, 1999
Medicare assignment
May accept Medicare assignment
Group practices
Triad Health Systems, Inc.Group PAC ID 4082798699, 21 clinicians

Practice addresses (Care Compare)

441 US Hwy 42 W
Warsaw, KY 41095-9561
Phone (859) 567-1591

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35775KYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Emergency Physicians LLC Emergency Medicine CurrentSince Jun 1, 2014 Accepting new patients
Triad Health Systems, Inc. CurrentSince Jan 30, 2019 Accepting new patients
Triad Health Systems, Inc. CurrentSince Jan 30, 2019 Accepting new patients
Triad Health Systems, Inc. Past Accepting new patients
Ky-I Medical Services, P.S.C. Past Accepting new patients
Owen Emergency Physicians Emergency Medicine Past Accepting new patients

Locations

329 Floyd Dr
Carrollton, KY 41008
Phone (502) 732-1082

1 Trillium Way
Corbin, KY 40701
Phone (606) 523-8521

299 Kings Daughters Dr
Hatton, KY 40601
Phone (502) 875-5240

120 Progress Way
Owenton, KY 40359
Phone (502) 227-2229

441 US Highway 42 W
Warsaw, KY 41095
Phone (859) 567-1271

Organizations & group practices 6

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 9

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": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543968000000",
    "number": "1285653618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 MADISON AVE",
            "city": "COVINGTON",
            "state": "KY",
            "postal_code": "410113313",
            "telephone_number": "859-655-6100",
            "fax_number": "859-655-6148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 PROGRESS WAY",
            "city": "OWENTON",
            "state": "KY",
            "postal_code": "403596032",
            "telephone_number": "844-655-6100",
            "fax_number": "502-484-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "LARRY",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2018-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "35775",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "35775",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64051022",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Owenton, KY

Sources for this page

Verify at the official NPI Registry.