Kelly Rayburn Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-08012 Issued in NC

Practice address

1002 N Church St Ste 302
Greensboro, NC 27401-1449

Phone

(336) 387-8100

Fax

(336) 387-8200

NPI assigned

Apr 5, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Ann Rayburn Former name

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Duke Health Integrated Practice IncGroup PAC ID 8325412737, 3,140 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Moses H. Cone Memorial Hospital, the Hospital, Greensboro, NC, CCN 340091

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kjohnson519546@direct.medicine.duke.edu

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.

• Duke Health Integrated Practice, Inc.

  • General Practice Physician
  • Durham, NC
  • NPI 1205553369
  Medicare reassignment Care Compare group NPD
• Duke Health Integrated Practice, Inc.

  dba Duke Health Integrated Practice Lake Norman

  • Family Medicine Physician
  • Mooresville, NC
  • NPI 1760288633
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Moses H. Cone Memorial Hospital Operating Corporation

  • General Acute Care Hospital
  • Greensboro, NC
  • NPI 1477591055
  Care Compare affiliation

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

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646697600000",
    "number": "1700382835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 N CHURCH ST STE 302",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011449",
            "telephone_number": "336-387-8100",
            "fax_number": "336-387-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 N CHURCH ST STE 302",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011449",
            "telephone_number": "336-387-8100",
            "fax_number": "336-387-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLY",
        "middle_name": "RAYBURN",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-05",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-08012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "RAYBURN",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeremy Johnson, P.A.-C
• Jessica Carroll Johnson
• Kadaja Johnson
• Kathleen Rose Johnson, PA-C
• Kathy La Rue Johnson
• Kelsey Johnson
• Kerrie Lynn Johnson, LPC
• Kia Sherette Marley Johnson, DMD
• Krista Johnson, LCMHC
• Krista Jean Johnson, PA-C

• Physician Assistant in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.