Kolby V Johnson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MR-1195 Issued in ID

Practice address

465 Memorial Dr
Pocatello, ID 83201-4008

Phone

(208) 282-4421

Fax

(208) 282-4818

NPI assigned

Jun 30, 2011

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

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family PracticeAlso: Hospitalist

Education

University of Oklahoma College of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pocatello Health Services LLCGroup PAC ID 6608927637, 171 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Heritage Home Health Home health agency, Pocatello, ID, CCN 137117
• Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028
• Power County Hospital District Hospital, American Falls, ID, CCN 131304
• Nell J Redfield Memorial Hospital Hospital, Malad City, ID, CCN 131303

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kjohnson263528@ahs.direct-ci.com

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.

• Pocatello Health Services, LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1689802852
  Medicare reassignment Care Compare group NPD
• Pocatello Health Services, LLC

  • Durable Medical Equipment & Medical Supplies
  • Pocatello, ID
  • NPI 1154089126
  NPD
• Pocatello Health Services, LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1215165485
  NPD
• Pocatello Hospital LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Heritage Home Health LLC

  • Home Health Agency
  • Pocatello, ID
  • NPI 1396074027
  Care Compare affiliation
• Oneida County Hospital

  • Critical Access Hospital
  • Malad, ID
  • NPI 1609826270
  Care Compare affiliation
• Pocatello Hospital LLC

  • Rehabilitation Hospital Unit
  • Pocatello, ID
  • NPI 1144262114
  Care Compare affiliation
• Pocatello Hospital LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  Care Compare affiliation
• Power County Hospital District

  • Critical Access Hospital
  • American Falls, ID
  • NPI 1609874932
  Care Compare affiliation

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

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309392000000",
    "number": "1326335134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "465 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014008",
            "telephone_number": "208-282-4421",
            "fax_number": "208-282-4818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014008",
            "telephone_number": "208-282-4421",
            "fax_number": "208-282-4818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KOLBY",
        "middle_name": "V",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-30",
        "last_updated": "2011-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "MR-1195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Lenae Johnson
• Brandon Johnson, PTA
• Eric D Johnson, DDS MS
• Gary L Johnson II, DC
• Joni Lynn Johnson, DPT
• Mark Johnson
• Parker Johnson, PT
• Shad Carl Johnson, PA-C
• Barry Johnston
• Lisa Gay Johnston

• Family Medicine Physician in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2011; 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.