Charles David Johnson, AGACNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

R875364 Issued in MS

Practice address

6051 U S Highway 49
Hattiesburg, MS 39401-7200

Phone

(601) 288-7000

Fax

(601) 450-0518

NPI assigned

May 24, 2015

Last updated

Jul 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

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

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Comprehensive Radiology Services PLLCGroup PAC ID 1759364946, 50 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Forrest General Hospital Hospital, Hattiesburg, MS, CCN 250078
• Forrest General Hospital Skilled Nursing Unit Nursing home, Hattiesburg, MS, CCN 255335

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

• Comprehensive Radiology Services, PLLC

  • Diagnostic Radiology Physician
  • Hattiesburg, MS
  • NPI 1992731590
  Medicare reassignment Care Compare group NPD
• South Mississippi Associate in Radiation Therapy, PLLC

  • Radiation Oncology Clinic/Center
  • Hattiesburg, MS
  • NPI 1114121373
  NPD (past)

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

• Forrest County General Hospital

  • General Acute Care Hospital
  • Hattiesburg, MS
  • NPI 1225041809
  Care Compare affiliation
• Forrest County General Hospital

  • Skilled Nursing Facility
  • Hattiesburg, MS
  • NPI 1659644474

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1432425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1437538410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 PROFESSIONAL PKWY STE 126",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394022647",
            "telephone_number": "601-450-0521",
            "fax_number": "601-450-0518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6051 U S HIGHWAY 49",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017200",
            "telephone_number": "601-288-7000",
            "fax_number": "601-450-0518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CHARLES",
        "middle_name": "DAVID",
        "credential": "AGACNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-24",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "R875364",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03600303",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chiedza Kristyne Jinya
• John McIntosh Turner (Hattiesburg Vision Clinic)
• Ashanti Johnson, PCMHT
• Candace Johnson, WHNP-BC
• Casey Eric Johnson, LCSW
• Daryl Aundra Johnson, M.D.
• Eva Johnson, RN
• Jeffrey A Johnson, MD
• John Alden Johnson III, M.D.
• John J Johnson, MD

• Acute Care Nurse Practitioner in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Acute Care Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.