NPIMap

Individual provider Active NPI

Shelly Johnson, MD

  • Internal Medicine Physician
  • South Kingstown, RI
National Provider Identifier
1528055191
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD08863 Issued in RI
Practice address
59 S County Commons Way FL H32
South Kingstown, RI 02879-8270
Phone
(401) 783-0084
Fax
(401) 782-0005
NPI assigned
Sep 29, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD08863 RI Primary

Addresses

Primary practice location

59 S County Commons Way FL H32
South Kingstown, RI 02879-8270

Mailing address

10 Davol SQ
Suite 400
Providence, RI 02903-4754
Phone (401) 421-4000

Other identifiers 2

IdentifierTypeStateIssuer
007056629OtherRIMEDICARE
7004665MedicaidRI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sjohnson220868@direct.lifespan.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20040628000640 RI Practitioner - Internal Medicine 4183600406 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Stanford University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Coastal Medical Physicians IncGroup PAC ID 0345658316, 222 clinicians

Practice addresses (Care Compare)

59 S County Commons Way
H3 2ND FL
Wakefield, RI 02879-8201
Phone (401) 783-0084

Hospital & facility affiliations

  • South County Home Health Home health agency, Wakefield, RI, CCN 417023
  • Bayada Home Health Care Inc Home health agency, Providence, RI, CCN 417057
  • Elara Caring Home health agency, Warwick, RI, CCN 417035
  • Hopehealth Hospice & Palliative Care Hospice, Providence, RI, CCN 411500
  • The Miriam Hospital Hospital, Providence, RI, CCN 410012
  • South County Hospital Inc Hospital, Wakefield, RI, CCN 410008
  • Newport Hospital Hospital, Newport, RI, CCN 410006
  • Rhode Island Hospital Hospital, Providence, RI, CCN 410007
  • Westerly Hospital Hospital, Westerly, RI, CCN 410013

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD08863RIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Medical Physicians, Inc. Internal Medicine CurrentSince Apr 25, 2021 Accepting new patients
Coastal Medical Physicians, Inc. Internal Medicine CurrentSince Apr 25, 2021 Accepting new patients
Lifespan Corporation Current Accepting new patients
Atlantic Professional Services of Rhode Island Incorporated Past Accepting new patients
Coastal Medical Inc Past Accepting new patients
Coastal Medical, Inc. Past Accepting new patients

Locations

900 Warren Ave
Ste 401
East Providence, RI 02914
Phone (401) 330-2480

272 W Exchange St
Ste 100
Providence, RI 02903
Phone (401) 421-5434

59 South County Commons Way
Fl 2
South Kingstown, RI 02879
Phone (401) 738-4323

59 South County Commons Way
Unit H2
Wakefield, RI 02879
Phone (401) 783-0084

59 South County Commons Way
Fl H32
Wakefield, RI 02879
Phone (401) 783-0084

70 Kenyon Ave
Ste 215
Wakefield, RI 02879
Phone (401) 783-0084

Interoperability endpoints

  • Direct secure messaging: sjohnson220868@brownhealth.medalliesdirect.net

Organizations & group practices 6

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.

Hospital & facility affiliations 12

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

NPI Registry JSON

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1528055191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 DAVOL SQ",
            "address_2": "SUITE 400",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034754",
            "telephone_number": "401-421-4000",
            "fax_number": "401-272-1456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 S COUNTY COMMONS WAY FL H32",
            "city": "SOUTH KINGSTOWN",
            "state": "RI",
            "postal_code": "028798270",
            "telephone_number": "401-783-0084",
            "fax_number": "401-782-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHELLY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-29",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD08863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "007056629",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7004665",
            "state": "RI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sjohnson220868@direct.lifespan.org",
            "affiliation": "N",
            "address_1": "59 S County Commons Way Fl H32",
            "city": "South Kingstown",
            "state": "RI",
            "country_code": "US",
            "postal_code": "028798270",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Kingstown, RI

Sources for this page

Verify at the official NPI Registry.