Active NPI
Kerry R Johnson, M.D.
- Pediatrics Physician
- Dallas, TX
National Provider Identifier
1366428641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- J5362
- Practice address
- 7777 Forest LN
Dallas, TX 75230-2505 - Phone
- (972) 758-3598
- NPI assigned
- Dec 19, 2005
- Sex
- Male
- 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 | J5362 | TX | |
| Pediatrics Physician | 208000000X | J5362 | TX | Primary |
Addresses
Primary practice location
7777 Forest LN
Dallas, TX 75230-2505
Mailing address
PO Box 201606
Dallas, TX 75320-1606
Phone (972) 758-3598
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8K9072 | Other | TX | BCBS |
| 89931K | Other | TX | BCBS |
| 84783F | Other | TX | BCBS |
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 |
|---|---|---|---|
| J5362 | TX | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alivedripcenters | Current | 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 and National Provider Directory roles.
-
- Infusion Therapy Clinic/Center
- Fairview, TX
- NPI 1063100071
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196726400000",
"number": "1366428641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 201606",
"city": "DALLAS",
"state": "TX",
"postal_code": "753201606",
"telephone_number": "972-758-3598"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7777 FOREST LN",
"city": "DALLAS",
"state": "TX",
"postal_code": "752302505",
"telephone_number": "972-758-3598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KERRY",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-19",
"last_updated": "2007-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "TX",
"license": "J5362",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "J5362",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8K9072",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "89931K",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "84783F",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.