Active NPI
Justin Michael Johnson, MD
- Psychiatry Physician
- Charlotte, NC
National Provider Identifier
1528223518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 2014-00163
- Practice address
- 1717 Sharon Rd W
Charlotte, NC 28210-5663 - Phone
- (980) 859-2106
- NPI assigned
- Jul 19, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 2014-00163 | NC | Primary |
Addresses
Primary practice location
1717 Sharon Rd W
Charlotte, NC 28210-5663
Mailing address
1717 Sharon Rd W
Charlotte, NC 28210-5663
Phone (980) 859-2106
Other practice location 1
1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 631-0002
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528223518 | Medicaid | NC | |
| NC2474 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2023 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2014-00163 | NC | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715904000000",
"number": "1528223518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 SHARON RD W",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282105663",
"telephone_number": "980-859-2106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 SHARON RD W",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282105663",
"telephone_number": "980-859-2106"
}
],
"practiceLocations": [
{
"address_1": "1000 Blythe Blvd",
"address_purpose": "LOCATION",
"city": "Charlotte",
"state": "NC",
"postal_code": "282035812",
"country_code": "US",
"telephone_number": "704-631-0002",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JOHNSON",
"first_name": "JUSTIN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-19",
"last_updated": "2024-05-17",
"certification_date": "2024-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NC",
"license": "2014-00163",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1528223518",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "NC2474",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.