John Kim Johnson, M.D.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

12867 Issued in SC

Practice address

200 Patewood Dr
Suite B260
Greenville, SC 29615-3593

Phone

(864) 454-4600

Fax

(864) 464-4605

NPI assigned

Jun 17, 2005

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 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Greenville Health System

  • General Acute Care Hospital
  • Simpsonville, SC
  • NPI 1679992838
  NPD (past)
• Greenville Proaxis Therapy, LLC

  • Physical Therapist
  • Greenville, SC
  • NPI 1669457859
  NPD (past)

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304899200000",
    "number": "1508861345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INDEPENDENCE PT",
            "address_2": "SUITE 212",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154566",
            "telephone_number": "864-797-6044",
            "fax_number": "864-797-6198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR",
            "address_2": "SUITE B260",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153593",
            "telephone_number": "864-454-4600",
            "fax_number": "864-464-4605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JOHN",
        "middle_name": "KIM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2011-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "SC",
            "license": "12867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00318488",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00801293",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128677",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF SC",
            "identifier": "576007863180",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamila Johnson
• Jeff O Johnson, D.M.D.
• Jill Johnson, CRNA
• Joel Alexander Johnson, CRNA
• Joel Daniel Johnson, DPT, PT
• Josette Jaqueline Johnson, M. D.
• Julie Comer Johnson, PHARMD
• Kaela Johnson
• Kelly Marie Johnson, MD
• Kelsey Mitchell Johnson

• Neurological Surgery Physician in Greenville, SC
• Providers in Greenville, SC by specialty
• Neurological Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.