Individual provider Active NPI

Caroline Judith Johnson, PA-C

  • Physician Assistant
  • Louisville, KY
National Provider Identifier
1669023891
Registry record updated Apr 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2562 Issued in KY
Practice address
3999 Dutchmans LN Ste 6F
Louisville, KY 40207-4724
Phone
(502) 394-5678
Fax
(502) 394-5600
NPI assigned
Sep 29, 2019
Last updated
Apr 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X TC872 KY
Physician Assistant 363A00000X PA2562 KY Primary

Addresses

Primary practice location

3999 Dutchmans LN Ste 6F
Louisville, KY 40207-4724

Mailing address

PO Box 776879
Chicago, IL 60677-6879
Phone (502) 588-9490

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address cjohnson87462@direct.nortonhealthcare.org
FHIR URL https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20191105001534 KY Practitioner - Physician Assistant 1658603055 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. Pediatric Orthopaedic Surgery CurrentSince Nov 1, 2019 Accepting new patients
Community Medical Associates, Inc. CurrentSince Nov 1, 2019 Accepting new patients
Norton Childrens Medical Group, LLC Physician Assistant Past Accepting new patients
Community Medical Associates, Inc. Pediatric Orthopaedic Surgery PastSince Oct 1, 2019 Accepting new patients

Locations

3999 Dutchmans Ln
Louisville, KY 40207
Phone (502) 394-5678

3999 Dutchmans Ln
Ste 6F
Louisville, KY 40207
Phone (502) 394-1999

601 S Floyd St
Ste 604
Louisville, KY 40202
Phone (502) 559-1670

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

9880 Angies Way
Ste 205
Louisville, KY 40241
Phone (502) 394-5678

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1569715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1669023891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776879",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776879",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3999 DUTCHMANS LN STE 6F",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074724",
            "telephone_number": "502-394-5678",
            "fax_number": "502-394-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CAROLINE",
        "middle_name": "JUDITH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-29",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "TC872",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA2562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cjohnson87462@direct.nortonhealthcare.org",
            "affiliation": "N",
            "address_1": "3999 Dutchmans Ln Ste 6F",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402074724",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicsoap.nortonhealthcare.org/FHIRPRD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3999 Dutchmans Ln Ste 6F",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402074724",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.