NPIMap

Individual provider Active NPI

Kendrick Dewayne Johnson, M.D.

  • Neurological Surgery Physician
  • New Orleans, LA
National Provider Identifier
1790122141
Registry record updated Jun 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
330499 Issued in LA
Practice address
1430 Tulane Ave # 8047
New Orleans, LA 70112-2632
Phone
(504) 988-3524
Fax
(504) 988-7846
NPI assigned
May 24, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 24, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 330499 LA Primary
Neurological Surgery Physician 207T00000X 125.063144 IL

Addresses

Primary practice location

1430 Tulane Ave # 8047
New Orleans, LA 70112-2632

Mailing address

1430 Tulane Ave # 8047
New Orleans, LA 70112-2632
Phone (504) 988-3524

Other practice location 1

15790 Paul Vega Md Dr
Hammond, LA 70403-1436
Phone (985) 345-2700

Other identifiers 1

IdentifierTypeStateIssuer
330499OtherLALICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, MS2 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
I20220805001311 LA Practitioner - Neurosurgery 4284955931 Reassigns benefits to 1 organization
I20221209001614 MS Practitioner - Neurosurgery 4284955931 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Louisiana State University School of Medicine in Shreveport, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

1340 Broad Ave
Suite 440
Gulfport, MS 39501-2460
Phone (228) 867-4856

1415 Tulane Ave
FL 5
New Orleans, LA 70112-2600
Phone (504) 988-5561

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.063144ILMDNeurological Surgery Physician
330499LAMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Current Accepting new patients
Administrators of the Tulane Educational Fund CurrentSince Aug 1, 2022 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Nov 14, 2022 Accepting new patients
Administrators of the Tulane Educational Fund CurrentSince Aug 1, 2022 Accepting new patients

Locations

15790 Paul Vega Md Dr
Hammond, LA 70403
Phone (985) 230-1682

1101 Medical Center Blvd
Marrero, LA 70072
Phone (504) 347-5511

4224 Houma Blvd
Ste 540
Metairie, LA 70006
Phone (504) 456-5108

4224 Houma Blvd
Ste 550
Metairie, LA 70006
Phone (504) 454-5213

2000 Canal St
New Orleans, LA 70112
Phone (504) 702-2287

1415 Tulane Ave
New Orleans, LA 70112
Phone (504) 588-2300

1430 Tulane Ave
#8047
New Orleans, LA 70112
Phone (504) 988-3524

1430 Tulane Ave
New Orleans, LA 70112
Phone (504) 585-6485

1415 Tulane Ave
Fl 5
New Orleans, LA 70112
Phone (504) 988-1001

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

Interoperability endpoints

  • Direct secure messaging: kendrick.johnson@direct.mhg.com

Organizations & group practices 5

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 64

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

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1369353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782259200000",
    "number": "1790122141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 TULANE AVE # 8047",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701122632",
            "telephone_number": "504-988-3524",
            "fax_number": "504-988-7846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 TULANE AVE # 8047",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701122632",
            "telephone_number": "504-988-3524",
            "fax_number": "504-988-7846"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15790 Paul Vega Md Dr",
            "address_purpose": "LOCATION",
            "city": "Hammond",
            "state": "LA",
            "postal_code": "704031436",
            "country_code": "US",
            "telephone_number": "985-345-2700",
            "fax_number": "985-230-6652",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENDRICK",
        "middle_name": "DEWAYNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-24",
        "last_updated": "2026-06-24",
        "certification_date": "2026-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "LA",
            "license": "330499",
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "IL",
            "license": "125.063144",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "330499",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Orleans, LA

Sources for this page

Verify at the official NPI Registry.