NPIMap

Individual provider Active NPI

Jeremy Wayne Johnson, D.O.

  • Family Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1457521874
Registry record updated Apr 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M8741 Issued in TX
Practice address
1500 S Main St
Fort Worth, TX 76104-4917
Phone
(817) 927-1200
NPI assigned
Mar 3, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 7, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X M8741 TX
Family Medicine Physician 207Q00000X M8741 TX Primary

Addresses

Primary practice location

1500 S Main St
Fort Worth, TX 76104-4917

Mailing address

732 Lionel Way
Fort Worth, TX 76108-4674
Phone (817) 683-0354

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20081120000130 TX Practitioner - Family PracticePractitioner - GastroenterologyPractitioner - Osteopathic Manipulative MedicinePractitioner - Obstetrics/GynecologyPractitioner - Emergency Medicine 7719047760 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine, Gastroenterology, Obstetrics/Gynecology, Osteopathic Manipulative Medicine
Education
Other, 2006
Medicare assignment
May accept Medicare assignment
Group practices
Jack County Hospital DistrictGroup PAC ID 5890768675, 20 clinicians
Olney-Hamilton Hospital DistrictGroup PAC ID 9133029077, 15 clinicians

Practice addresses (Care Compare)

215 Chisholm TRL
Jacksboro, TX 76458-1403
Phone (940) 567-6633

901 W Hamilton St
Hamilton Hospital Medical Associates
Olney, TX 76374-1725
Phone (940) 564-5521

Hospital & facility affiliations

  • Beyondfaith Homecare & Rehab of Graham LLC Home health agency, Graham, TX, CCN 677917
  • Healing Hands Healthcare LLC Home health agency, Wichita Falls, TX, CCN 677101
  • Centerwell Home Health Home health agency, Plano, TX, CCN 678210
  • Above & Beyond Home Health & Rehab Home health agency, Fort Worth, TX, CCN 747754
  • Solaris Hospice Inc Hospice, Decatur, TX, CCN 451688
  • Faith Community Hospital Hospital, Jacksboro, TX, CCN 450241
  • Hamilton Hospital Hospital, Olney, TX, CCN 451354
  • Graham Regional Medical Center Hospital, Graham, TX, CCN 671300
  • United Regional Health Care System Hospital, Wichita Falls, TX, CCN 450010
  • Lincoln County Medical Center Hospital, Ruidoso, NM, CCN 321306
  • Avir at Jacksboro Nursing home, Jacksboro, TX, CCN 455808
  • Avir at Graham Nursing home, Graham, TX, CCN 455555
  • Olney Rehabilitation and Care Center Nursing home, Olney, TX, CCN 455611
  • Hamilton Hospital Nursing home, CCN 45Z354

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M8741TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Concord Medical Group PLLC Emergency Medicine CurrentSince Feb 24, 2013 Accepting new patients
Olney-Hamilton Hospital District Current Accepting new patients
Jack County Hospital District CurrentSince Feb 1, 2021 Accepting new patients
Graham Healthcare PLLC Family Medicine Current Accepting new patients
Olney-Hamilton Hospital District Emergency Medicine CurrentSince Apr 11, 2017 Accepting new patients
Olney-Hamilton Hospital District CurrentSince Apr 11, 2017 Accepting new patients
Jack County Hospital District Family Medicine CurrentSince Feb 1, 2021 Accepting new patients
Olney Hamilton Hospital District CurrentSince Jan 1, 2023 Accepting new patients
Concord Medical Group of Texas PLLC Emergency Medicine CurrentSince Feb 24, 2013 Accepting new patients
Lumin Urgent Care, PLLC PastSince Aug 1, 2016 Accepting new patients
Jack County Hospital District Past Accepting new patients

Locations

1601 W 11th Pl
Big Spring, TX 79720
Phone (432) 263-1211

200 S Geneva St
Breckenridge, TX 76424
Phone (254) 559-2241

1416 George Dieter Dr
El Paso, TX 79936
Phone (877) 822-6281

1005 State Highway 16 S
Graham, TX 76450
Phone (940) 282-2512

1005 State Highway 16 S
#P
Graham, TX 76450
Phone (940) 282-2512

310 W South St
Henrietta, TX 76365
Phone (806) 647-2191

215 Chisholm Trl
Jacksboro, TX 76458
Phone (940) 567-5528

100 S Avenue M
Olney, TX 76374
Phone (940) 564-3546

101 S Ave M
Olney, TX 76374
Phone (940) 564-3546

901 W Hamilton St
Olney, TX 76374
Phone (940) 564-3546

Interoperability endpoints

  • Direct secure messaging: jeremy.johnson.1@16039.direct.athenahealth.com
  • Direct secure messaging: jeremy.johnson.1@11284.direct.athenahealth.com
  • Direct secure messaging: jjohnson@direct.fchtexas.com
  • FHIR API: https://api.platform.athenahealth.com/16039/brand/2/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Olney Rehabilitation and Care CenterOlney, TX, CCN 455611 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 1, 2024
Oct 1, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 20

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.

View all 20

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1204502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270598400000",
    "number": "1457521874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 LIONEL WAY",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761084674",
            "telephone_number": "817-683-0354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S MAIN ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044917",
            "telephone_number": "817-927-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JEREMY",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-03",
        "last_updated": "2010-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "M8741",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "M8741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.