NPIMap

Individual provider Active NPI

Stephen E. Johnson, M.D.

  • Emergency Medicine Physician
  • Knightdale, NC
National Provider Identifier
1780667501
Registry record updated Feb 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
21409 Issued in NC
Practice address
6602 Knightdale Blvd
Suite 102
Knightdale, NC 27545-6525
Phone
(919) 747-5210
Fax
(919) 747-5211
NPI assigned
Nov 25, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 42431 CO
Emergency Medicine Physician 207P00000X 21409 NC Primary

Addresses

Primary practice location

6602 Knightdale Blvd
Suite 102
Knightdale, NC 27545-6525

Mailing address

6602 Knightdale Blvd
Suite 102
Knightdale, NC 27545-6525
Phone (919) 747-5210

Other identifiers 1

IdentifierTypeStateIssuer
45904324MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21409NCMDPharmacist
42431COMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Raleigh Emergency Medicine Associates Inc Emergency Medicine Past Accepting new patients
Rex Hospital Inc Past Accepting new patients
Rex Hospital, Inc. Past Accepting new patients
Trinidad Area Health Association Past Accepting new patients

Organizations & group practices 4

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": "1132876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391472000000",
    "number": "1780667501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6602 KNIGHTDALE BLVD",
            "address_2": "SUITE 102",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275456525",
            "telephone_number": "919-747-5210",
            "fax_number": "919-747-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6602 KNIGHTDALE BLVD",
            "address_2": "SUITE 102",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275456525",
            "telephone_number": "919-747-5210",
            "fax_number": "919-747-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "STEPHEN",
        "middle_name": "E.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-25",
        "last_updated": "2014-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "42431",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "21409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45904324",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knightdale, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.