Kenneth M Johnson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1375 Issued in SD

Practice address

901 4TH St NW
Watertown, SD 57201-1558

Phone

(605) 886-8471

Fax

(605) 886-9317

NPI assigned

Jan 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414368000000",
    "number": "1306825864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-886-8471",
            "fax_number": "605-886-9317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 4TH ST NW",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572011558",
            "telephone_number": "605-886-8471",
            "fax_number": "605-886-9317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENNETH",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-12",
        "last_updated": "2014-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "1375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5609073",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leah Jessen
• John Boer, PC
• Elizabeth Rae Johnson, P.A.
• Francine Johnson
• Isaac George Johnson, DC
• Kristopher B Johnson, MD
• Mary Kay Johnson, LCSW CSW PIP QMNP
• Michael Jerome Johnson, O.D.
• Nicole Johnson
• Scott A Johnson, D.C.

• Family Medicine Physician in Watertown, SD
• Providers in Watertown, SD by specialty
• Family Medicine Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2014; 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.