Individual provider Active NPI

Kristen C Johnson

  • Physician Assistant
  • Beaufort, SC
National Provider Identifier
1336300078
Registry record updated Jul 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1310 Issued in SC
Practice address
Beaufort Memorial Lowcountry Medical Group
300 Midtown Drive
Beaufort, SC 29906-5200
Phone
(843) 770-0404
Fax
(844) 296-2309
NPI assigned
Jun 24, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1310 SC Primary

Addresses

Primary practice location

Beaufort Memorial Lowcountry Medical Group
300 Midtown Drive
Beaufort, SC 29906-5200

Mailing address

955 Ribaut Rd
Bmac Credentialing
Beaufort, SC 29902-5441
Phone (843) 522-5674

Other identifiers 1

IdentifierTypeStateIssuer
0673PAMedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20080813000935 SC Practitioner - Physician Assistant 3779658539 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beaufort County Memorial HospitalGroup PAC ID 7810809365, 197 clinicians

Practice addresses (Care Compare)

300 Midtown Dr
Beaufort, SC 29906-5200
Phone (843) 770-0404

989 Ribaut Rd
Beaufort, SC 29902-5472

Hospital & facility affiliations

  • Beaufort County Memorial Hospital Hospital, Beaufort, SC, CCN 420067
  • Hampton Regional Medical Center Hospital, Varnville, SC, CCN 420072

Merit-based Incentive Payment System (MIPS)

Final score
86.95 of 100Reported as group
Quality
83.15
Promoting interoperability
100
Improvement activities
40
Cost
73.35

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Beaufort County Memorial Hospital Physician Assistant CurrentSince Oct 1, 2018 Accepting new patients
Beaufort County Memorial Hospital Past Accepting new patients
Beaufort Emergency Medicine, PA Past Accepting new patients
Beaufort County Memorial Hospital Past Accepting new patients

Locations

989 Ribaut Rd
Ste 103
Beaufort, SC 29902
Phone (843) 522-5351

300 Midtown Dr
Beaufort, SC 29906
Phone (843) 379-7746

955 Ribaut Rd
#C
Beaufort, SC 29902

955 Ribaut Rd
Beaufort, SC 29902
Phone (803) 522-5200

Interoperability endpoints

  • Direct secure messaging: kristen.johnson.1@16436.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563926400000",
    "number": "1336300078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 RIBAUT RD",
            "address_2": "BMAC CREDENTIALING",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025441",
            "telephone_number": "843-522-5674",
            "fax_number": "843-522-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BEAUFORT MEMORIAL LOWCOUNTRY MEDICAL GROUP",
            "address_2": "300 MIDTOWN DRIVE",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299065200",
            "telephone_number": "843-770-0404",
            "fax_number": "844-296-2309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KRISTEN",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-24",
        "last_updated": "2019-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "1310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0673PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaufort, SC

Sources for this page

Verify at the official NPI Registry.