Kelly Deanne John, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-12240 Issued in NC

Practice address

8936 Blakeney Professional Dr
Charlotte, NC 28277-6660

Phone

(704) 943-3714

NPI assigned

Jul 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC, TN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cumberland Skin Surgery and DermatologyGroup PAC ID 0941391338, 55 clinicians

Skin Surgery Center PAGroup PAC ID 3173599479, 72 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

90.65 of 100Reported as group

Promoting interoperability

89

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JCHICA

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.

• Skin Surgery Center PA

  • Dermatology Physician
  • Winston Salem, NC
  • NPI 1649237082
  Medicare reassignment Care Compare group
• Cumberland Skin Surgery and Dermatology

  • Medical Specialty Clinic/Center
  • Lebanon, TN
  • NPI 1922138247
  Medicare reassignment Care Compare group
• Vieta Dermatology, PLLC

  • Dermatology Physician
  • Pinehurst, NC
  • NPI 1942713052
  Medicare reassignment
• Skin Surgery Center PA

  • MOHS-Micrographic Surgery Physician
  • Mount Pleasant, SC
  • NPI 1851810279
  NPD
• Advanced Sleep Consultants of Middle TN, Inc

  • Medical Specialty Clinic/Center
  • Lebanon, TN
  • NPI 1912048307
  NPD (past)
• Brentwood Dermatology

  • Specialist
  • Brentwood, TN
  • NPI 1841409323
  NPD (past)
• North Florida Multispecialty Physicians LLC

  • Cardiovascular Disease Physician
  • Jacksonville, FL
  • NPI 1639593213
  NPD (past)

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739318400000",
    "number": "1295764165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 PROFESSIONAL PARK DR STE 150",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031307",
            "telephone_number": "336-607-8061",
            "fax_number": "336-724-6123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8936 BLAKENEY PROFESSIONAL DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282776660",
            "telephone_number": "704-943-3714"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Trotter Hills Cir",
            "address_purpose": "LOCATION",
            "city": "Pinehurst",
            "state": "NC",
            "postal_code": "283747930",
            "country_code": "US",
            "telephone_number": "910-420-1282",
            "fax_number": "904-273-8511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHN",
        "first_name": "KELLY",
        "middle_name": "DEANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-02",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9101452",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Walsh DDS PA
• John Walsh DDS PA
• John Walsh DDS PA
• John Walsh DDS,PA
• Gracious John, PA
• Trent Everard Dirk John, MD
• John'S Sunshine Haven, LLC
• Ashley Johns
• Deborah Johns, OGNP
• Katherine A Johns, LMHC

• Physician Assistant in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; 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.