Kimberly Ann Johnson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601005757 Issued in MI

Practice address

3601 W 13 Mile Rd
Physician Extender
Royal Oak, MI 48073-6712

Phone

(248) 898-4021

Fax

(248) 898-1473

NPI assigned

Jun 17, 2010

Last updated

Aug 16, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Kimberly Ann Shaw Former name

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

• Baraga County Memorial Hospital

  dba BCMH Physician Group

  • Family Medicine Physician
  • L'Anse, MI
  • NPI 1851409643
  Medicare reassignment NPD
• Aspirus Iron River Hospital & Clinics, Inc.

  dba Aspirus Iron River Hospital

  • Critical Access Hospital
  • Iron River, MI
  • NPI 1497750830
  Medicare reassignment
• Aspirus Iron River Hospital & Clinics, Inc.

  dba Aspirus Iron River Clinic

  • Rural Health Clinic/Center
  • Iron River, MI
  • NPI 1306344783
  NPD
• Aspirus Iron River Hospital & Clinics, Inc.

  dba Northstar Home Care & Hospice

  • Community Based Hospice Care Agency
  • Iron River, MI
  • NPI 1609066356
  NPD
• Baraga County Memorial Hospital

  • Emergency Medicine Physician
  • L'Anse, MI
  • NPI 1508960600
  NPD
• Baraga County Memorial Hospital

  dba Baraga County Home Care & Hospice

  • Home Health Agency
  • L'Anse, MI
  • NPI 1932218807
  NPD
• Iema Indiana

  • Emergency Medicine Physician
  • Williamsport, IN
  • NPI 1952891269
  NPD
• Dickinson County Healthcare System

  dba Marshfield Medical Center - Dickinson Professional Services

  • Emergency Medical Services (Emergency Medicine) Physician
  • Iron Mountain, MI
  • NPI 1891751186

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1276732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313452800000",
    "number": "1720309362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 STEPHENSON HIGHWAY",
            "address_2": "WILLIAM BEAUMONT HOSPITAL PAYOR CONTRACT SERVICES",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831103",
            "telephone_number": "248-577-3520",
            "fax_number": "248-577-3526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 W 13 MILE RD",
            "address_2": "PHYSICIAN EXTENDER",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736712",
            "telephone_number": "248-898-4021",
            "fax_number": "248-898-1473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-17",
        "last_updated": "2011-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "SHAW",
            "middle_name": "ANN",
            "prefix": "MS.",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Aubrey Johnson, M.A. CCC-SLP
• Cynthia Jo Johnson
• Erin Ashley Johnson
• Janet Marie Johnson
• Jared Alan Johnson, MD
• Matthew D Johnson, M.D.
• Robert L Johnson, PAC
• Ryan Johnson, M.D.
• Samantha Renae Johnson
• Storm Johnson

• Physician Assistant in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2011; 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.