Individual provider Active NPI

Clanford Lyonel Johnson, M.D.

  • Family Medicine Physician
  • Greer, SC
National Provider Identifier
1750342879
Registry record updated Jul 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25112 Issued in SC
Practice address
1305 S Suber Rd
Greer, SC 29650-0944
Phone
(864) 989-4609
NPI assigned
Mar 29, 2006
Last updated
Jul 29, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 200400688 NC
Family Medicine Physician 207Q00000X 25112 SC Primary

Addresses

Primary practice location

1305 S Suber Rd
Greer, SC 29650-0944

Mailing address

1 Independence PT
Suite 212
Greenville, SC 29615-4545
Phone (864) 797-6044

Other identifiers 2

IdentifierTypeStateIssuer
P00329935OtherNCRAILROAD MEDICARE
5904663MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20041122001091 NC Practitioner - Family Practice 3476518192 Reassigns benefits to 4 organizations
I20150901000343 SC Practitioner - Family Practice 3476518192 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of South Alabama College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1200 N Elm St
Greensboro, NC 27401-1004
Phone (336) 832-7000

1200 N Elm St
Greensboro, NC 27401-1020

501 N Elam Ave
Greensboro, NC 27403-1118
Phone (336) 832-1000

618 S Main St
Reidsville, NC 27320-5020
Phone (336) 951-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Aug 3, 2015 Accepting new patients
Moses Cone Physician Services, Inc. Family Medicine Current Accepting new patients
Prisma Health University Medical Group Family Medicine CurrentSince Aug 3, 2015 Accepting new patients
Moses Cone Physician Services Inc CurrentSince Apr 1, 2011 Accepting new patients
The Moses H Cone Memorial Hospital Operating Corporation Family Medicine CurrentSince May 12, 2014 Accepting new patients
Moses Cone Medical Services, Inc. Family Medicine CurrentSince Oct 6, 2010 Accepting new patients
Moses Cone Medical Services, Inc. Family Medicine CurrentSince Oct 6, 2010 Accepting new patients
24 On Physicians, P.C. CurrentSince Aug 8, 2009 Accepting new patients
The Moses H Cone Memorial Hospital Operating Corporation CurrentSince May 12, 2014 Accepting new patients
24 On Physicians, P.C. CurrentSince Aug 8, 2009 Accepting new patients
Wake Forest University Health Sciences Past Accepting new patients

Locations

1200 N Elm St
Greensboro, NC 27401
Phone (336) 574-7000

201 E Wendover Ave
Greensboro, NC 27401
Phone (336) 275-6318

301 E Wendover Ave
Ste 411
Greensboro, NC 27401
Phone (336) 832-3200

3990 US Highway 64 E
Murphy, NC 28906
Phone (828) 837-5939

940 Golf House Ct E
Whitsett, NC 27377
Phone (336) 449-9848

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

11402 Anderson Rd
Ste A
Greenville, SC 29611
Phone (864) 631-2799

2A Cleveland Ct
Greenville, SC 29607
Phone (864) 271-7761

1305 S Suber Rd
Greer, SC 29650
Phone (864) 989-4609

1115 Wren School Rd
Piedmont, SC 29673
Phone (864) 859-0740

Interoperability endpoints

  • Direct secure messaging: cjohnson14887@direct.conehealth.com

Organizations & group practices 11

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.

Hospital & facility affiliations 1

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": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438128000000",
    "number": "1750342879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INDEPENDENCE PT",
            "address_2": "SUITE 212",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154545",
            "telephone_number": "864-797-6044",
            "fax_number": "864-797-6198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 S SUBER RD",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296500944",
            "telephone_number": "864-989-4609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CLANFORD",
        "middle_name": "LYONEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2015-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200400688",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "25112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00329935",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5904663",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greer, SC

Sources for this page

Verify at the official NPI Registry.