Stephen D Johnson, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R863721 Issued in MS

Practice address

969 Lakeland Dr
Jackson, MS 39216-4606

Phone

(601) 200-2000

NPI assigned

Dec 9, 2010

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 1

Medicare fee-for-service enrollment

Enrolled in MS

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

Specialty

Nurse Practitioner

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Radiation Oncology of Mississippi PAGroup PAC ID 6800787961, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Dominic-Jackson Memorial Hospital Hospital, Jackson, MS, CCN 250048

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sjohnson5340355@direct.casso.us.com

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.

• Radiation Oncology of Mississippi PA

  • Radiation Oncology Physician
  • Jackson, MS
  • NPI 1003905266
  Medicare reassignment Care Compare group NPD

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

• St Dominic-Jackson Memorial Hospital

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1306876065
  Care Compare affiliation

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

{
    "created_epoch": "1291852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334793600000",
    "number": "1598068892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "813 WEDGEWOOD CT",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390476366",
            "telephone_number": "601-665-4355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164606",
            "telephone_number": "601-200-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "STEPHEN",
        "middle_name": "D",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-09",
        "last_updated": "2012-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R863721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02335251",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sammy Vaun Johnson, AGACNP
• Shacaria Johnson
• Sharetta Johnson, LCSW
• Shurunda Johnson
• Sidney A Johnson Jr., MD
• Stephen J Johnson, LCSW
• Tameka Johnson, RD, CLC, CCP
• Tasha Johnson
• Terrence Zebedee Johnson
• Thomas Bradley Johnson, CRNA

• Family Nurse Practitioner in Jackson, MS
• Providers in Jackson, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2012; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.