Individual provider Active NPI

Jacqueline Michelle Johnson, NP

  • Adult Health Nurse Practitioner
  • Kansas City, MO
National Provider Identifier
1720579808
Registry record updated Aug 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
2017040108 Issued in MO
Practice address
4321 Washington St Ste 6100
Kansas City, MO 64111
Phone
(816) 932-3470
Fax
(816) 932-6888
NPI assigned
May 23, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 8, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diabetes Educator Registered Nurse 163WD0400X 124618 MO
Gerontology Nurse Practitioner 363LG0600X 2017040108 MO
Adult Health Nurse Practitioner 363LA2200X 2017040108 MO Primary

Addresses

Primary practice location

4321 Washington St Ste 6100
Kansas City, MO 64111

Mailing address

901 E 104TH St
Mailstop 400N
Kansas City, MO 64131-4517
Phone (816) 502-7104

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20180816000998 MO Practitioner - Nurse Practitioner 6103175690 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saint Lukes Physician Group IncGroup PAC ID 3577476894, 1,233 clinicians

Practice addresses (Care Compare)

20 NE Saint Lukes Blvd
Suite 200
Lees Summit, MO 64086-6001
Phone (816) 347-5100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.56 of 100Reported as group
Quality
76.07
Promoting interoperability
100
Improvement activities
40
Cost
65.79

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
124618MOMDDiabetes Educator Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Luke'S Physician Group Inc CurrentSince Aug 27, 2018 Accepting new patients

Locations

901 E 104th St
#400N
Kansas City, MO 64131
Phone (816) 502-8756

4321 Washington St
Ste 6100
Kansas City, MO 64111
Phone (816) 932-2707

20 NE Saint Lukes Blvd
Ste 200
Lees Summit, MO 64086
Phone (816) 347-5100

601 S US Highway 169
Smithville, MO 64089
Phone (816) 532-3999

Interoperability endpoints

  • Direct secure messaging: jjohnson6979@direct.saint-lukes.org

Organizations & group practices 1

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533686400000",
    "number": "1720579808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 E 104TH ST",
            "address_2": "MAILSTOP 400N",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641314517",
            "telephone_number": "816-502-7104",
            "fax_number": "816-932-3492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4321 WASHINGTON ST STE 6100",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "64111",
            "telephone_number": "816-932-3470",
            "fax_number": "816-932-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACQUELINE",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-23",
        "last_updated": "2018-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "MO",
            "license": "124618",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2017040108",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2017040108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.