Individual provider Active NPI

Kelly Laine Johnson, NP

  • Nurse Practitioner
  • Stanford, CA
National Provider Identifier
1689984239
Registry record updated Mar 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
19162 Issued in CA
Practice address
300 Pasteur Dr
Stanford, CA 94305-2200
Phone
(650) 497-8000
NPI assigned
Oct 18, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 10, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 695748 CA
Acute Care Nurse Practitioner 363LA2100X 19162 CA
Nurse Practitioner 363L00000X 19162 CA Primary

Addresses

Primary practice location

300 Pasteur Dr
Stanford, CA 94305-2200

Mailing address

300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 497-8000

Other practice location 1

751 S. Bascom Ave
San Jose, CA 95128
Phone (408) 885-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20180306002080 CA Practitioner - Nurse Practitioner 1355568635 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
88.53 of 100Reported as group
Quality
87.08
Promoting interoperability
100
Improvement activities
40
Cost
69.51

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
695748CAMDRegistered Nurse
19162CAMDCertified Respiratory Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Stanford Health Care CurrentSince Jan 28, 2018 Accepting new patients
Stanford Health Care CurrentSince Jan 28, 2018 Accepting new patients
LPCH Medical Group Div of Lucile CurrentSince Jan 28, 2018 Accepting new patients

Locations

300 Pasteur Dr
Palo Alto, CA 94304
Phone (650) 723-6469

725 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8979

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1287360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678406400000",
    "number": "1689984239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-497-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-497-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "751 S. Bascom Ave",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "95128",
            "country_code": "US",
            "telephone_number": "408-885-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLY",
        "middle_name": "LAINE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-18",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "695748",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "19162",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "19162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanford, CA

Sources for this page

Verify at the official NPI Registry.