Individual provider Active NPI

Jarvis Jamal Johnson, MD

  • Family Medicine Physician
  • Columbia, SC
National Provider Identifier
1942825500
Registry record updated Jan 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
84170 Issued in SC
Practice address
229 Longtown Rd
Columbia, SC 29229-8550
Phone
(803) 419-4949
NPI assigned
Jun 10, 2020
Last updated
Jan 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2024

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 84170 SC Primary

Addresses

Primary practice location

229 Longtown Rd
Columbia, SC 29229-8550

Mailing address

PO Box 6069
West Columbia, SC 29171-6069
Phone (803) 791-2203

Other practice location 1

Prisma Health Family Medicine Center
3209 Colonial Drive
Columbia, SC 29203
Phone (803) 434-6113

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jjohnson167404@direct.lexmed.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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

Enrollment IDStateProvider typePAC IDDetails
I20240111004612 SC Practitioner - Family Practice 7517318785 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Alabama School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lexington Health IncGroup PAC ID 2567872070, 905 clinicians

Practice addresses (Care Compare)

230 Redhawk Way
Suite 200
Blythewood, SC 29016-9286
Phone (803) 419-4949

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
84170SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lexington County Health Services District Inc Current Accepting new patients
Lexington Health Inc Family Medicine Current Accepting new patients
Lexington Health Inc CurrentSince Aug 15, 2023 Accepting new patients
Lexington Health Inc CurrentSince Aug 15, 2023 Accepting new patients
Lexington County Health Services District, Inc. Past Accepting new patients

Locations

230 Redhawk Way
Ste 200
Blythewood, SC 29016
Phone (803) 419-4949

21 Gateway Corners Park
Ste 101
Columbia, SC 29203
Phone (803) 419-4949

229 Longtown Rd
Columbia, SC 29229
Phone (803) 419-4949

811 W Main St
Ste 101
Lexington, SC 29072
Phone (803) 936-7230

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 1

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": "1591747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1942825500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6069",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291716069",
            "telephone_number": "803-791-2203",
            "fax_number": "803-791-2203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 LONGTOWN RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292298550",
            "telephone_number": "803-419-4949"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Prisma Health Family Medicine Center",
            "address_2": "3209 Colonial Drive",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "29203",
            "country_code": "US",
            "telephone_number": "803-434-6113",
            "fax_number": "803-434-8478",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JARVIS",
        "middle_name": "JAMAL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-10",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "84170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jjohnson167404@direct.lexmed.com",
            "affiliation": "N",
            "address_1": "229 Longtown Rd",
            "city": "Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "292298550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.