Active NPI
Kimberly Dale Johnson, MD
- Emergency Medicine Physician
- Farmington, NM
National Provider Identifier
1316960032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- MD2009-0511
- Practice address
- 4820 East Main Street
Sjrmc Urgent Care
Farmington, NM 87402 - Phone
- (505) 609-6495
- Fax
- (505) 609-6496
- NPI assigned
- Jul 25, 2006
- Last updated
- Oct 14, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 32573 | CO | |
| Emergency Medicine Physician | 207P00000X | MD2009-0511 | NM | Primary |
Addresses
Primary practice location
4820 East Main Street
Sjrmc Urgent Care
Farmington, NM 87402
Mailing address
PO Box 4002
Durango, CO 81302-4002
Phone (970) 884-0548
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01325737 | Medicaid | CO | |
| K5584 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32573 | CO | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwest Emergency Physicians, PC | Emergency Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Durango, CO
- NPI 1568495653
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350172800000",
"number": "1316960032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4002",
"city": "DURANGO",
"state": "CO",
"postal_code": "813024002",
"telephone_number": "970-884-0548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4820 EAST MAIN STREET",
"address_2": "SJRMC URGENT CARE",
"city": "FARMINGTON",
"state": "NM",
"postal_code": "87402",
"telephone_number": "505-609-6495",
"fax_number": "505-609-6496"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KIMBERLY",
"middle_name": "DALE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-25",
"last_updated": "2012-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "CO",
"license": "32573",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NM",
"license": "MD2009-0511",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01325737",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "K5584",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Farmington, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.