NPIMap

Individual provider Active NPI

Kim Johnson, D.O.

  • Obstetrics & Gynecology Physician
  • Escanaba, MI
National Provider Identifier
1922058361
Registry record updated Mar 31, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
5101013033 Issued in MI
Practice address
3409 Ludington St
Suite 204
Escanaba, MI 49829-4212
Phone
(906) 786-1356
Fax
(906) 789-4503
NPI assigned
May 10, 2006
Last updated
Mar 31, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 5101013033 MI Primary

Addresses

Primary practice location

3409 Ludington St
Suite 204
Escanaba, MI 49829-4212

Mailing address

3409 Ludington St
Suite 204
Escanaba, MI 49829-4212
Phone (906) 786-1356

Other identifiers 2

IdentifierTypeStateIssuer
1922058361MedicaidMI
5211399OtherBCBS

Other names 1

  • Dr. Kim Thornton Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200319002067 VT Practitioner - Obstetrics/Gynecology 1456431881 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1315 Hospital Dr
Saint Johnsbury, VT 05819-9210

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Vermont Regional Hospital Inc. CurrentSince Mar 5, 2020 Accepting new patients
Northeastern Vermont Regional Hospital, Inc Obstetrics & Gynecology CurrentSince Mar 5, 2020 Accepting new patients
U P Otolaryngology PC Past Accepting new patients
Northeastern Vermont Regional Hospital, Inc Past Accepting new patients
Ashwin H Shah MD PC Past Accepting new patients

Locations

1315 Hospital Dr
St Johnsbury, VT 05819
Phone (802) 748-3638

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/uc35511_ashwinshahmd

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 3

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": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269993600000",
    "number": "1922058361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3409 LUDINGTON ST",
            "address_2": "SUITE 204",
            "city": "ESCANABA",
            "state": "MI",
            "postal_code": "498294212",
            "telephone_number": "906-786-1356",
            "fax_number": "906-789-4503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3409 LUDINGTON ST",
            "address_2": "SUITE 204",
            "city": "ESCANABA",
            "state": "MI",
            "postal_code": "498294212",
            "telephone_number": "906-786-1356",
            "fax_number": "906-789-4503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2010-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "5101013033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922058361",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5211399",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "THORNTON",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Escanaba, MI

Sources for this page

Verify at the official NPI Registry.