NPIMap

Organization Active NPI

Johnston Specialty Physician Services, Inc.

  • Gastroenterology Physician
  • Smithfield, NC
National Provider Identifier
1497031827
Registry record updated Oct 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
JOHNSTON SPECIALTY PHYSICIAN SERVICES, INC.
Practice address
514 N Brightleaf Blvd
Suite 1610
Smithfield, NC 27577-4407
Phone
(919) 938-7182
Fax
(919) 938-7185
NPI assigned
Oct 31, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2011

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

Authorized official

Name
Tracey Woodruff
Title
Manager
Phone
(919) 938-7182

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

514 N Brightleaf Blvd
Suite 1610
Smithfield, NC 27577-4407

Mailing address

PO Box 63366
Charlotte, NC 28263-3366
Phone (866) 430-0564

Other names 1

  • Johnston Medical Associates Gastroenterology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081022000184 NC Part B Supplier - Clinic/Group Practice 1052479979 Receives reassigned benefits from 19 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clayton, NC; Smithfield, NC

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1320019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320019200000",
    "number": "1497031827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 63366",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282633366",
            "telephone_number": "866-430-0564",
            "fax_number": "919-967-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 N BRIGHTLEAF BLVD",
            "address_2": "SUITE 1610",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "275774407",
            "telephone_number": "919-938-7182",
            "fax_number": "919-938-7185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSTON SPECIALTY PHYSICIAN SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-31",
        "last_updated": "2011-10-31",
        "status": "A",
        "authorized_official_last_name": "WOODRUFF",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "919-938-7182"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Johnston Medical Associates Gastroenterology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Smithfield, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.