NPIMap

Individual provider Active NPI

Walter Kip Johnson, M.D.

  • General Practice Physician
  • Ione, CA
National Provider Identifier
1780919282
Registry record updated Mar 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
G32232 Issued in CA
Practice address
305 Preston Ave
Ione, CA 95640-9158
Phone
(209) 742-6144
NPI assigned
Oct 16, 2009
Last updated
Mar 3, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X G32232 CA Primary

Addresses

Primary practice location

305 Preston Ave
Ione, CA 95640-9158

Mailing address

PO Box 939
Angels Camp, CA 95222-0939
Phone (209) 754-6262

Other practice location 1

12140 New York Ranch Rd
Jackson, CA 95642-9407
Phone (209) 257-2400

Other names 1

  • Dr. W. Kip Johnson Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20091222000598 CA Practitioner - General PracticePractitioner - Preventive Medicine 1557401593
I20241127002649 TX Practitioner - General PracticePractitioner - Family Practice 1557401593 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General PracticeAlso: Family Practice
Education
Other, 1975
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

305 Preston Ave
Ione, CA 95640-9158
Phone (209) 674-6182

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
M a C T Health Board Incorporated Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: walterkip.johnson.p1@direct.macthealth.nextgenshare.com

Organizations & group practices 2

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 5

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": "1255651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677801600000",
    "number": "1780919282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 939",
            "city": "ANGELS CAMP",
            "state": "CA",
            "postal_code": "952220939",
            "telephone_number": "209-754-6262",
            "fax_number": "209-754-6275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 PRESTON AVE",
            "city": "IONE",
            "state": "CA",
            "postal_code": "956409158",
            "telephone_number": "209-742-6144"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12140 New York Ranch Rd",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "CA",
            "postal_code": "956429407",
            "country_code": "US",
            "telephone_number": "209-257-2400",
            "fax_number": "209-257-2403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "WALTER",
        "middle_name": "KIP",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-10-16",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "G32232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "W.",
            "last_name": "JOHNSON",
            "middle_name": "KIP",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Ione, CA

Sources for this page

Verify at the official NPI Registry.