Jerry C Johnson, MD

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

MD019829E Issued in PA

Practice address

3615 Chestnut St
Ralston Penn Center
Philadelphia, PA 19104

Phone

(215) 662-2746

Fax

(215) 349-5648

NPI assigned

Jun 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• University of Penn - Medical Group

  • Geriatric Medicine (Internal Medicine) Physician
  • Philadelphia, PA
  • NPI 1497767495
  Medicare reassignment NPD
• University of Penn-Medical Group

  • Surgical Oncology Physician
  • Philadelphia, PA
  • NPI 1871981985
  NPD
• Health Promotion Council of Southeastern Pennsylvania, Inc.

  • Registered Dietitian
  • Philadelphia, PA
  • NPI 1326427022
  NPD (past)

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332460800000",
    "number": "1669415972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3615 CHESTNUT ST",
            "address_2": "RALSTON PENN CENTER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042612",
            "telephone_number": "215-662-2746",
            "fax_number": "215-349-5648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 CHESTNUT ST",
            "address_2": "RALSTON PENN CENTER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-662-2746",
            "fax_number": "215-349-5648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JERRY",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2012-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "PA",
            "license": "MD019829E",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD019829E",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0007361000007",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Johnson, CRNA
• Janee Johnson, MSW, LSW
• Jaynay Chanel Johnson
• Jennifer L Johnson, MS,CCC-SLP
• Jennifer Maria Johnson, MD, PHD
• Jessica Johnson, DO
• Jessica Lynn Johnson, PA-C, MS
• Jessie Lynn Johnson, MFT
• Jill Bishop Johnson, M.D.
• Jill C Johnson, CRNP

• Geriatric Medicine (Internal Medicine) Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Geriatric Medicine (Internal Medicine) Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.