NPIMap

Individual provider Active NPI

Kelly Rose Johnson

  • Surgery Physician
  • Bronx, NY
National Provider Identifier
1427410281
Registry record updated Apr 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
310107-01 Issued in NY
Practice address
1521 Jarret PL
Bronx, NY 10461-2606
Phone
(718) 862-8840
NPI assigned
Mar 22, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X OT017016 PA
Student in an Organized Health Care Education/Training Program 390200000X
Surgery Physician 208600000X 310107-01 NY Primary

Addresses

Primary practice location

1521 Jarret PL
Bronx, NY 10461-2606

Mailing address

206 Brooksite Dr
Smithtown, NY 11787-4443
Phone (845) 656-4818

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20210920002951 NY Practitioner - Surgical Oncology 0547556946 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Surgical Oncology
Education
Philadelphia College of Osteopathic Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

255 W Montauk Hwy
Life Care Ctr
Hampton Bays, NY 11946
Phone (631) 723-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
310107-01NYMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Surgical Associates, University Faculty Practice Corporati Surgery CurrentSince Oct 13, 2025 Accepting new patients
Montefiore Medical Center Surgery CurrentSince Aug 13, 2021 Accepting new patients
North Shore Hematology Oncology Associates PC CurrentSince Sep 5, 2021 Accepting new patients
Montefiore Medical Center CurrentSince Aug 13, 2021 Accepting new patients
Stony Brook Anaesthesiology, University Faculty Practice Corporation Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

1521 Jarret Pl
Bronx, NY 10461
Phone (718) 239-8733

500 Commack Rd
Ste 102A
Commack, NY 11725
Phone (631) 638-0130

3111 New Hyde Park Rd
North New Hyde Pk, NY 11042
Phone (516) 365-6100

1500 Route 112
Bldg 4
Port Jefferson Station, NY 11776
Phone (631) 574-8354

48 Route 25A
Smithtown, NY 11787
Phone (631) 862-3540

Lauterbur Dr Level 5
Rm 5M0203
Stony Brook, NY 11794

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: kjohnson65715@northwell.direct-ci.com

Organizations & group practices 5

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 6

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": "1458604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650672000000",
    "number": "1427410281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 BROOKSITE DR",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117874443",
            "telephone_number": "845-656-4818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 JARRET PL",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612606",
            "telephone_number": "718-862-8840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLY",
        "middle_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-22",
        "last_updated": "2022-04-23",
        "certification_date": "2022-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "OT017016",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "310107-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.