Kaleb Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10003658A Issued in IN

Practice address

8051 S Emerson Ave Ste 200
Indianapolis, IN 46237-8632

Phone

(317) 865-2955

Fax

(317) 865-2944

NPI assigned

Feb 1, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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 and National Provider Directory roles.

• Community Physicians of Indiana Inc

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1619105244
  Medicare reassignment NPD
• Indianapolis Gastroenterology, LLC

  dba Indianapolis Gastroenterology & Hepatology

  • Gastroenterology Physician
  • Indianapolis, IN
  • NPI 1518964493
  Medicare reassignment
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1612137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674604800000",
    "number": "1518558691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8051 S EMERSON AVE STE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462378632",
            "telephone_number": "317-865-2955",
            "fax_number": "317-865-2944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8051 S EMERSON AVE STE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462378632",
            "telephone_number": "317-865-2955",
            "fax_number": "317-865-2944"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7201 Burlat Ln",
            "address_purpose": "LOCATION",
            "city": "Noblesville",
            "state": "IN",
            "postal_code": "460628488",
            "country_code": "US",
            "telephone_number": "260-920-8331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KALEB",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-01",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10003658A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerrod Johnson
• Jessica Marie Johnson, NP-C
• Jill Johnson, PMHNP-BC
• Jill M Johnson, ASSOCIATES
• Jodie L Johnson, M.D.
• Karen A Johnson, NP
• Katelyn Marie Johnson, PA-C
• Kathleen Johnson, RBT
• Kaylee Johnson
• Kelly Johnson, RBT

• Physician Assistant in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.