NPIMap

Individual provider Active NPI

Kenneth Travis Johnson Jr., M.D.

  • Family Medicine Physician
  • Pineville, LA
National Provider Identifier
1932182201
Registry record updated Apr 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
017148 Issued in LA
Practice address
2812 Highway 28 E
Pineville, LA 71360-5715
Phone
(318) 528-3355
Fax
(318) 528-3356
NPI assigned
Nov 21, 2005
Last updated
Apr 3, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 3, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20051219000867 LA Practitioner - Family Practice 2769404706 Reassigns benefits to 2 organizations
Practice locations: Pineville, LA

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
Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

2812 Hwy 28 E
Pineville, LA 71360-5715
Phone (318) 528-3355

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
017148LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas Family Medicine CurrentSince Dec 1, 2020 Accepting new patients
C H Wilkinson Physician Network Family Medicine CurrentSince Dec 5, 2016 Accepting new patients
C H Wilkinson Physician Network CurrentSince Dec 5, 2016 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Dec 1, 2020 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

101 Medical Park Blvd
Pineville, LA 71360
Phone (318) 445-9538

101 Medical Park Blvd
Ste C
Pineville, LA 71360
Phone (318) 445-9538

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

1 Saint Mary Pl
Shreveport, LA 71101
Phone (318) 681-4500

1453 E Bert Kouns Industrial Loop
Shreveport, LA 71105
Phone (318) 681-4138

919 Hidden Rdg
Irving, TX 75038

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/996/brand/1/csg/213/fhir/r4
  • Direct secure messaging: 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 31

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

View all 31

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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pineville, LA

Sources for this page

Verify at the official NPI Registry.