NPIMap

Individual provider Active NPI

Kurt E Johnson, M.D., INC.

  • General Practice Physician
  • Chico, CA
National Provider Identifier
1407881741
Registry record updated Apr 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
G59768 Issued in CA
Practice address
1040 Mangrove Ave
Chico, CA 95926-3509
Phone
(530) 345-0064
Fax
(530) 345-0080
NPI assigned
Jul 12, 2006
Last updated
Apr 12, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2013

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 G59768 CA
General Practice Physician 208D00000X G59768 CA Primary

Addresses

Primary practice location

1040 Mangrove Ave
Chico, CA 95926-3509

Mailing address

1040 Mangrove Ave
Chico, CA 95926-3509
Phone (530) 345-0064

Other identifiers 1

IdentifierTypeStateIssuer
00G597680MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20040414001764 CA Practitioner - Family Practice 9830184449 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loma Linda University School of Medicine, 1981
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Mangrove Medical GroupGroup PAC ID 0143260687, 10 clinicians

Practice addresses (Care Compare)

1040 Mangrove Ave
Chico, CA 95926-3509

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy74
Upper gastrointestinal (GI) endoscopy for acid reflux11
Melanoma (skin cancer) excision1-10
Removal of skin lesions71
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Enloe Medical Center Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kurt.johnson.1@15385.direct.athenahealth.com

Organizations & group practices 2

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 9

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": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365724800000",
    "number": "1407881741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 MANGROVE AVE",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959263509",
            "telephone_number": "530-345-0064",
            "fax_number": "530-345-0080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 MANGROVE AVE",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959263509",
            "telephone_number": "530-345-0064",
            "fax_number": "530-345-0080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KURT",
        "middle_name": "E",
        "credential": "M.D., INC.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2013-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G59768",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "G59768",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G597680",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chico, CA

Sources for this page

Verify at the official NPI Registry.