Active NPI
Kenneth Travis Johnson Jr., M.D.
- Family Medicine Physician
- Pineville, LA
National Provider Identifier
1932182201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 017148
- Practice address
- 2812 Highway 28 E
Pineville, LA 71360-5715 - Phone
- (318) 528-3355
- Fax
- (318) 528-3356
- NPI assigned
- Nov 21, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 017148 | LA | Primary |
Addresses
Primary practice location
2812 Highway 28 E
Pineville, LA 71360-5715
Mailing address
919 Hidden RDG
Irving, TX 75038-3813
Phone (469) 282-2711
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356280 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Louisiana State University School of Medicine in Shreveport, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2812 Hwy 28 E
Pineville, LA 71360-5715
Phone (318) 528-3355
Hospital & facility affiliations
- Stat Home Health-Central
- Lagniappe Homecare Alexandria
- Amedisys Home Health Services
- Louisiana Homecare of Alexandria
- Home Health Care 2000- Oakdale
- Christus St Frances Cabrini Hospital
- Willis Knighton Medical Center
- Rapides Regional Medical Center
- Christus Central Louisiana Surgical Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017148 | LA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christus Trinity Clinic Texas | Current | Accepting new patients | |
| C H Wilkinson Physician Network | Current | Accepting new patients | |
| Christus Trinity Clinic Texas | Family Medicine | Current | Accepting new patients |
| C H Wilkinson Physician Network | Family Medicine | Current | Accepting new patients |
| Primary Care Specialists,LLC | Family Medicine | Past | Accepting new patients |
| Trinity Clinic | Family Medicine | Past | Accepting new patients |
Locations
3802 Prescott Rd
Alexandria, LA 71301
Phone (318) 487-6060
2812 Highway 28 E
Pineville, LA 71360
Phone (318) 528-3355
2812 Highway 28 E
Ste 104
Pineville, LA 71360
65 Medical Park Blvd
Pineville, LA 71360
Phone (318) 445-6363
101 Medical Park Blvd
Pineville, LA 71360
Phone (318) 445-9538
101 Medical Park Blvd
Ste C
Pineville, LA 71360
Phone (318) 445-9538
1453 E Bert Kouns Industrial Loop
Shreveport, LA 71105
Phone (318) 681-4138
1 Saint Mary Pl
Shreveport, LA 71101
Phone (318) 681-4500
919 Hidden Rdg
Irving, TX 75038
Interoperability endpoints
- https://api.platform.athenahealth.com/996/brand/1/csg/213/fhir/r4
- kjohnson242860@christushealth.direct-ci.net
Organizations & group practices 6
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.
-
- Orthopaedic Surgery Physician
- Corpus Christi, TX
- NPI 1750826095
-
- Rural Health Clinic/Center
- Winnsboro, TX
- NPI 1801673165
-
- Family Medicine Physician
- Alexandria, LA
- NPI 1346273190
-
- Family Medicine Physician
- Tyler, TX
- NPI 1922058304
Hospital & facility affiliations 31
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Alexandria, LA
- NPI 1912150814
-
- General Acute Care Hospital
- Alexandria, LA
- NPI 1164750840
-
- Student Health Clinic/Center
- Pineville, LA
- NPI 1023139458
Hospital
-
- Student Health Clinic/Center
- Pineville, LA
- NPI 1093836421
Hospital
-
- Student Health Clinic/Center
- Provencal, LA
- NPI 1164687307
Hospital
-
- Student Health Clinic/Center
- Natchitoches, LA
- NPI 1356462782
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491177600000",
"number": "1932182201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "919 HIDDEN RDG",
"city": "IRVING",
"state": "TX",
"postal_code": "750383813",
"telephone_number": "469-282-2711",
"fax_number": "469-282-0996"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2812 HIGHWAY 28 E",
"city": "PINEVILLE",
"state": "LA",
"postal_code": "713605715",
"telephone_number": "318-528-3355",
"fax_number": "318-528-3356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KENNETH",
"middle_name": "TRAVIS",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-21",
"last_updated": "2017-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "LA",
"license": "017148",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1356280",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pineville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2017; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.