Edward Alex Johnson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0101249802 Issued in VA

Practice address

811 Redgate Ave
Norfolk, VA 23507-1515

Phone

(757) 668-7007

NPI assigned

Apr 9, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in VA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Childrens Specialty Group PLLC

  • Pediatrics Physician
  • Norfolk, VA
  • NPI 1255354130
  Medicare reassignment NPD
• Virginia Hospitalists Inc

  • Internal Medicine Physician
  • Richmond, VA
  • NPI 1427047562
  NPD (past)
• Greenville Health System

  • General Acute Care Hospital
  • Simpsonville, SC
  • NPI 1679992838
  NPD (past)
• Greenville Proaxis Therapy, LLC

  • Physical Therapist
  • Greenville, SC
  • NPI 1669457859
  NPD (past)

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550534400000",
    "number": "1902079015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 REDGATE AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 REDGATE AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071515",
            "telephone_number": "757-668-7007"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Moye Blvd",
            "address_2": "ECU Pediatrics",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "278344300",
            "country_code": "US",
            "telephone_number": "252-744-2335",
            "fax_number": "252-744-3811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "EDWARD",
        "middle_name": "ALEX",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-09",
        "last_updated": "2019-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101249802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "186RL",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "315974",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902079015",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittany Nicole Johnson, LPC
• Charles Johnson
• Christopher Brent Johnson, PA
• Danielle Johnson, PA-C
• David A Johnson, M.D.
• Gracie Beth Johnson, APRN
• Janell Johnson
• Jeanelle Johnson, PA-C
• Julie Bailey Johnson, PA-C
• Justin Johnson, PA

• Pediatrics Physician in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Pediatrics Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.