Kevin M Johnson, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

M7963 Issued in ID

Practice address

608 Northwest Blvd
Suite 301
Coeur D Alene, ID 83814-2174

Phone

(208) 676-8346

Fax

(208) 664-5345

NPI assigned

Aug 31, 2006

Last updated

Sep 1, 2016By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Coeur D'Alene Surgical and Vein

  • Medical Specialty Clinic/Center
  • Coeur d'Alene, ID
  • NPI 1225368632
  Authorized official Same address or phone
• Lake City Surgeons PLLC

  • Surgery Physician
  • Coeur d'Alene, ID
  • NPI 1659483410
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472688000000",
    "number": "1679685598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 NORTHWEST BLVD",
            "address_2": "SUITE 301",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142174",
            "telephone_number": "208-676-8346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 NORTHWEST BLVD",
            "address_2": "SUITE 301",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142174",
            "telephone_number": "208-676-8346",
            "fax_number": "208-664-5345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KEVIN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2016-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ID",
            "license": "M7963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807104000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Todd Johnson, DO
• Julie Michelle Johnson, PHARMD
• Juliette Johnson, DPT
• Justine Johnson
• Kaesha Johnson
• Kimberly Anne Johnson, LCPC
• Maryjayne Mabrey Johnson, ARNP
• Robert John Johnson, O.D.
• Simone Johnson, LMSW
• Tyler W Johnson, DO

• Surgery Physician in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.