NPIMap

Individual provider Active NPI

Kenneth S Johnson, MD

  • Emergency Medical Services (Emergency Medicine) Physician
  • Grand Rapids, MI
National Provider Identifier
1558378265
Registry record updated Aug 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
4301057997 Issued in MI
Practice address
100 Michigan St NE
Grand Rapids, MI 49503-2560
Phone
(616) 391-1680
NPI assigned
Aug 2, 2006
Last updated
Aug 21, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 4301057997 MI
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 4301057997 MI Primary

Addresses

Primary practice location

100 Michigan St NE
Grand Rapids, MI 49503-2560

Mailing address

PO Box 22067
Lansing, MI 48909-8016
Phone (616) 975-1845

Other identifiers 2

IdentifierTypeStateIssuer
930077745OtherMIRAILROAD MEDICARE
P00411572OtherMIRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20070622000204 MI Practitioner - Emergency MedicinePractitioner - Addiction Medicine 1052410651 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Addiction Medicine
Education
Wayne State University School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Center for Physical Rehabilitation IncGroup PAC ID 6901717768, 352 clinicians
Center for Physical Rehabilitation and Therapy LPGroup PAC ID 0941513303, 365 clinicians

Practice addresses (Care Compare)

5060 Cascade Rd
Suite a
Grand Rapids, MI 49546-3808

5060 Cascade Rd SE
Suite a
Grand Rapids, MI 49546-3808

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cherry Street Services, Inc. CurrentSince Jan 8, 2018 Accepting new patients
Cherry Street Services, Inc CurrentSince Jan 8, 2018 Accepting new patients
Ecs Western Michigan PC Anesthesiology CurrentSince Aug 1, 2018 Accepting new patients
Catherine's Health Center PastSince Jan 1, 2023 Accepting new patients

Locations

100 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 965-8209

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

550 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 235-7272

615 S Bower St
Greenville, MI 48838
Phone (616) 754-4341

8333 Felch St
Ste 200
Zeeland, MI 49464
Phone (616) 748-2850

Interoperability endpoints

  • Direct secure messaging: kenneth.johnson.1@29288.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 13

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Catherine's Health CenterGrand Rapids, MI, CCN 231112 Federally qualified health center Corporate Director Jan 1, 2023
Catherine's Health Dental CenterGrand Rapids, MI, CCN 231163 Federally qualified health center Corporate Director (7.69%) Jan 1, 2023
Catherine's Health Center Streams of HopeGrand Rapids, MI, CCN 231164 Federally qualified health center Corporate Director (7.69%) Jan 1, 2023
Catherine's Health Center WyomingWyoming, MI, CCN 231182 Federally qualified health center Corporate Director Jan 1, 2023
Catherine's Health Center TownlineGrand Rapids, MI, CCN 231185 Federally qualified health center Corporate Officer Jan 1, 2023
Catherines Health Center at Crossroads Bible ChurchGrand Rapids, MI, CCN 231198 Federally qualified health center Corporate Officer Jan 1, 2023
Catherine's Health Center - Mel TrotterGrand Rapids, MI, CCN C71009 Federally qualified health center Corporate Officer Jan 1, 2023
Catherine's Health Center - CrossroadsGrand Rapids, MI, CCN C71013 Federally qualified health center Corporate Officer Jan 1, 2023
Catherine's Health Center - CrestwoodKentwood, MI, CCN C71015 Federally qualified health center Corporate Officer Jan 1, 2023
Catherine's Health Center Godfrey ElementaryWyoming, MI, CCN C71032 Federally qualified health center Corporate Director (7.69%) Jan 1, 2023
Catherine's Health Center AyaGrand Rapids, MI, CCN C71042 Federally qualified health center Corporate Officer Jan 1, 2023
Catherine's Health Center DegageGrand Rapids, MI, CCN C71048 Federally qualified health center Corporate Officer Jan 1, 2023
Catherine's Health Center HarrisonGrand Rapids, MI, CCN C71050 Federally qualified health center Corporate Officer Jan 1, 2023

Owned or controlled facilities with NPI records 13

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 13

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566345600000",
    "number": "1558378265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22067",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489098016",
            "telephone_number": "616-975-1845",
            "fax_number": "616-285-0846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-391-1680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENNETH",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2019-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301057997",
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "MI",
            "license": "4301057997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "930077745",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00411572",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.