NPIMap

Individual provider Active NPI

Kevin Alexander Johnston, MD

  • Family Medicine Physician
  • Owosso, MI
National Provider Identifier
1639630742
Registry record updated Oct 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301506530 Issued in MI
Practice address
239 N State Rd
Owosso, MI 48867-9075
Phone
(989) 743-3415
NPI assigned
Mar 29, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301506530 MI Primary

Addresses

Primary practice location

239 N State Rd
Owosso, MI 48867-9075

Mailing address

239 N State Rd
Owosso, MI 48867-9075
Phone (989) 743-3415

Other practice location 1

111 E 210th St
Bronx, NY 10467-2401
Phone (718) 920-2341

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
I20220607000688 MI Practitioner - Family Practice 9537547385 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorial Hospital 210 clinicians
Powerback Rehabilitation LLC 600 clinicians

Practice addresses (Care Compare)

239 N State Rd
101 MH Family Medicine Corunna
Owosso, MI 48867-9075
Phone (989) 743-3415

4775 Village Dr
Grand Ledge, MI 48837-8107
Phone (517) 412-2240

Hospital & facility affiliations

  • Memorial Healthcare Home health agency, Owosso, MI, CCN 237101
  • Memorial Healthcare Hospital, Owosso, MI, CCN 230121
  • Edward W Sparrow Hospital Hospital, Lansing, MI, CCN 230230

Merit-based Incentive Payment System (MIPS)

Final score
82.58 of 100Reported as group
Quality
58.15
Promoting interoperability
100
Improvement activities
40
Cost
74.45

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301506530MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital Family Medicine CurrentSince Aug 1, 2022 Accepting new patients
Memorial Hospital CurrentSince Aug 1, 2022 Accepting new patients
Memorial Hospital Family Medicine Current Accepting new patients
Memorial Hospital Past Accepting new patients
Memorial Hospital Past Accepting new patients
Memorial Hospital Past Accepting new patients
Memorial Hospital Past Accepting new patients

Locations

9000 Peet Rd
Chesaning, MI 48616
Phone (989) 720-2273

9099 E Lansing Rd
Ste B
Durand, MI 48429
Phone (989) 288-0400

218 W Main St
Ste 300
Flushing, MI 48433
Phone (989) 723-5211

218 W Main St
Ste 100
Flushing, MI 48433
Phone (989) 720-7562

826 W King St
Owosso, MI 48867
Phone (989) 720-2273

239 N State Rd
Owosso, MI 48867
Phone (989) 743-3415

239 N State Rd
Ste 101
Owosso, MI 48867
Phone (989) 725-8688

1002 E M 21
Ste 100
Owosso, MI 48867
Phone (989) 720-5400

3337 Britton Rd
Perry, MI 48872
Phone (517) 625-3004

Interoperability endpoints

  • Direct secure messaging: memorialhc@memorialhealthcare.midirect.net
  • Direct secure messaging: k.johnston@memorialhealthcare.midirect.net

Organizations & group practices 11

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 4

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": "1553817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1639630742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "239 N STATE RD",
            "city": "OWOSSO",
            "state": "MI",
            "postal_code": "488679075",
            "telephone_number": "989-743-3415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 N STATE RD",
            "city": "OWOSSO",
            "state": "MI",
            "postal_code": "488679075",
            "telephone_number": "989-743-3415"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 E 210th St",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104672401",
            "country_code": "US",
            "telephone_number": "718-920-2341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "KEVIN",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-29",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301506530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Owosso, MI

Sources for this page

Verify at the official NPI Registry.