NPIMap

Individual provider Active NPI

Kent Michael Johnson, M.D.

  • Internal Medicine Physician
  • Goodyear, AZ
National Provider Identifier
1386699502
Registry record updated Sep 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
24416 Issued in AZ
Practice address
14541 W Indian School Road
Ste 600
Goodyear, AZ 85395
Phone
(623) 535-5599
Fax
(623) 535-4696
NPI assigned
May 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 24416 AZ Primary
Pediatrics Physician 208000000X 24416 AZ

Addresses

Primary practice location

14541 W Indian School Road
Ste 600
Goodyear, AZ 85395

Mailing address

14541 W. Indian School Rd.
Ste. 600
Goodyear, AZ 85395
Phone (623) 535-5599

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040508000066 AZ Practitioner - Pediatric Medicine 6002805967 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Michigan State University College of Human Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Medical Group Arizona LLCGroup PAC ID 3173872835, 152 clinicians

Practice addresses (Care Compare)

14541 W Indian School Rd
Suite 600
Goodyear, AZ 85395-9243
Phone (888) 698-6727

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
24416AZMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group Arizona LLC Internal Medicine CurrentSince Aug 1, 2018 Accepting new patients
Arizona Primary Care Physicians, LLC CurrentSince Aug 1, 2015 Accepting new patients
Estrella Internal Medicine and Pediatrics Current Accepting new patients
Sun Health Corporation Past Accepting new patients
Allen Family Medicine PLLC Past Accepting new patients

Locations

5620 W Thunderbird Rd
Ste F1
Glendale, AZ 85306
Phone (602) 938-6960

14541 W Indian School Rd
#600
Goodyear, AZ 85395
Phone (623) 535-5599

14502 W Meeker Blvd
Sun City West, AZ 85375
Phone (623) 214-4000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21654/brand/1/csg/1/fhir/r4
  • Direct secure messaging: kent.johnson.1@19654.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/22064/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.platform.athenahealth.com/19654/brand/1/csg/1/fhir/r4

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316476800000",
    "number": "1386699502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14541 W. INDIAN SCHOOL RD.",
            "address_2": "STE. 600",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "85395",
            "telephone_number": "623-535-5599",
            "fax_number": "623-535-4696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14541 W INDIAN SCHOOL ROAD",
            "address_2": "STE 600",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "85395",
            "telephone_number": "623-535-5599",
            "fax_number": "623-535-4696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENT",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2011-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "24416",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "24416",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

Verify at the official NPI Registry.