NPIMap

Individual provider Active NPI

Kevin Earl Johnson, MD

  • Family Medicine Physician
  • Rural Hall, NC
National Provider Identifier
1336138809
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9801320 Issued in NC
Practice address
290 W Wall St
Rural Hall, NC 27045-9308
Phone
(336) 969-9158
Fax
(336) 969-4554
NPI assigned
Oct 18, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 070497 GA
Family Medicine Physician 207Q00000X 9801320 NC Primary

Addresses

Primary practice location

290 W Wall St
Rural Hall, NC 27045-9308

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (336) 969-9158

Other practice location 1

3409 Thomasville Rd
Winston Salem, NC 27107-5438
Phone (743) 229-3300

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kevin.johnsonmd.p2@direct.gmg.nextgenshare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, GA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060727000092 NC Practitioner - Family PracticePractitioner - Hospice/Palliative Care 0143249110 Reassigns benefits to 1 organization
I20140228000363 GA Practitioner - Family Practice 0143249110 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9801320NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Hospital, Inc. CurrentSince Jan 1, 2014 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Dec 21, 2024 Accepting new patients
Gwinnett Medical Group, Inc Family Medicine Current Accepting new patients
Gwinnett Pathology Assoc PC Current Accepting new patients
Northside Hospital, Inc. CurrentSince Jan 1, 2014 Accepting new patients
Gwinnett Physician Group, LLC Family Medicine CurrentSince Jan 1, 2014 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Dec 21, 2024 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Health Sciences Foundation Inc. Past Accepting new patients

Locations

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

665 Duluth Hwy
Ste 501
Lawrenceville, GA 30046
Phone (678) 312-0400

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

290 W Wall St
Rural Hall, NC 27045
Phone (336) 969-1185

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: kjohnson1170867@direct.novanthealth.org

Organizations & group practices 22

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.

View all 22

Hospital & facility affiliations 4

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

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Hospice/Palliative Care
Education
University of Oklahoma College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLC 2,413 clinicians

Practice addresses (Care Compare)

10810 Mallard Creek Rd
Charlotte, NC 28262-9786
Phone (704) 510-8000

Hospital & facility affiliations

  • Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014
  • Northside Hospital Hospital, Atlanta, GA, CCN 110161
  • Northside Hospital Gwinnett Hospital, Lawrenceville, GA, CCN 110087
  • Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

NPI Registry JSON

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1336138809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "336-969-9158",
            "fax_number": "336-969-4554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 W WALL ST",
            "city": "RURAL HALL",
            "state": "NC",
            "postal_code": "270459308",
            "telephone_number": "336-969-9158",
            "fax_number": "336-969-4554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3409 Thomasville Rd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271075438",
            "country_code": "US",
            "telephone_number": "743-229-3300",
            "fax_number": "743-229-3324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KEVIN",
        "middle_name": "EARL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "070497",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9801320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kevin.johnsonmd.p2@direct.gmg.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "direct messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "direct edge",
            "address_1": "665 Duluth Hwy",
            "address_2": "Suite 501",
            "city": "Lawrenceville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300463328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rural Hall, NC

Sources for this page

Verify at the official NPI Registry.