Kaddijatou Sanyang Johnson, PA-C, MMS

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-05462 Issued in NC

Practice address

10208 Cerny St Ste 110
Raleigh, NC 27617-7885

Phone

(984) 215-4590

Fax

(984) 215-4591

NPI assigned

Jan 5, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kaddijatou Sanyang Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Unc Physicians Network LLCGroup PAC ID 5496940546, 985 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rex Hospital Hospital, Raleigh, NC, CCN 340114

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Unc Physicians Network LLC

  • Family Medicine Physician
  • Pittsboro, NC
  • NPI 1750704367
  Medicare reassignment Care Compare group
• Moore Medical Group Inc

  • Family Medicine Physician
  • Lake Mary, FL
  • NPI 1578724183

  NC

  Medicare reassignment
• Unc Physicians Network LLC

  • General Practice Physician
  • Morrisville, NC
  • NPI 1558786830
  NPD
• Unc Physicians Network LLC

  • Pediatrics Physician
  • Chapel Hill, NC
  • NPI 1932523206
  NPD
• Raleigh Durham Medical Group PA

  • Family Medicine Physician
  • Cary, NC
  • NPI 1295784874
  NPD (past)

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

• Rex Hospital Inc.

  • General Acute Care Hospital
  • Raleigh, NC
  • NPI 1497797088
  Care Compare affiliation

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

{
    "created_epoch": "1420416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694736000000",
    "number": "1356739015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5221 PARAMOUNT PKWY STE 220",
            "city": "MORRISVILLE",
            "state": "NC",
            "postal_code": "275605490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10208 CERNY ST STE 110",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276177885",
            "telephone_number": "984-215-4590",
            "fax_number": "984-215-4591"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 Garner Rd",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "27610",
            "country_code": "US",
            "telephone_number": "919-556-1008",
            "fax_number": "919-556-6099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KADDIJATOU",
        "middle_name": "SANYANG",
        "credential": "PA-C, MMS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-05",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-05462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ksanyang181104@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "10208 Cerny St Ste 110",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276177885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KADDIJATOU",
            "last_name": "SANYANG",
            "credential": "PA-C, MMS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jerusha Johnson, MS, CCC-SLP
• Jerval Johnson
• Joshua Johnson, DPT
• Julie Johnson
• Ka'Marla Johnson
• Kaitlyn Nicole Johnson
• Kayla Johnson, NP
• Keenon Johnson, DDS, MS
• Keesha Johnson, M.S.,M.ED.
• Kellie Johnson

• Physician Assistant in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; 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.