Walter Kip Johnson, M.D.
Individual provider Active NPI General Practice Physician · Ione, CA
NPI 1780919282 · NPPES record last updated Mar 3, 2023
Key facts
- NPI
- 1780919282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- G32232 (CA)
- Practice address
- 305 Preston Ave
Ione, CA 95640-9158 - Phone
- (209) 742-6144
- NPI assigned
- Oct 16, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- General Practice
- Education
- Other, 1975
- Medicare assignment
- May accept Medicare assignment
- Group practices
- M a C T Health Board Incorporated
Practice addresses (Care Compare)
305 Preston Ave
Ione, CA 95640-9158
Phone (209) 674-6182
Hospital & facility affiliations
- Iron Point Home Health Care Inc
- United Home Care of Northern California
- Sutter Care at Home
- Sutter Amador Hospital
- Sutter Medical Center, Sacramento
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091222000598 | CA | Practitioner - General Practice |
1557401593 | |
| I20241127002649 | TX | Practitioner - General Practice |
1557401593 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| M a C T Health Board Incorporated | Past | Accepting new patients |
Interoperability endpoints
- walterkip.johnson.p1@direct.macthealth.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | G32232 | CA | Yes |
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
- Dr. W. Kip Johnson
Other providers in Ione, CA
- Evalyn Horowitz
- Marilyn Sue Immoos
- Ione Family Chiropractic
- Biju John
- Stephanie Jo Ann Johnson
- Karanveer Dhillon DDS Inc
- Kathleen Ann Keller
- Dawn Kettell-Ness
- Patricia P Khoo
- John George Klopping
All providers in Ione, CA · General Practice Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.