David Shane Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA024 Issued in MS

Practice address

376A Simpson Highway 149
Magee, MS 39111-3409

Phone

(601) 849-1475

Fax

(601) 849-1549

NPI assigned

May 17, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-usa.unify.chbase.com/org/covingc-3983785e
• Direct secure messaging: davidjohnson@mscm.allscriptsdirect.net

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.

• Covington County Hospital

  • Rural Health Clinic/Center
  • Seminary, MS
  • NPI 1134435498

  MS

  Medicare reassignment Care Compare group NPD
• Covington County Hospital

  • Rural Health Clinic/Center
  • Taylorsville, MS
  • NPI 1306460282

  MS

  Medicare reassignment Care Compare group NPD
• Covington County Hospital

  • Rural Health Clinic/Center
  • Mt. Olive, MS
  • NPI 1336447861

  MS

  Medicare reassignment Care Compare group NPD
• Covington County Hospital

  • Rural Health Clinic/Center
  • Collins, MS
  • NPI 1518260330

  MS

  Medicare reassignment Care Compare group NPD
• Covington County Hospital

  • Rural Health Clinic/Center
  • Collins, MS
  • NPI 1598769044

  MS

  Medicare reassignment Care Compare group NPD
• Covington County Hospital

  • Rural Health Clinic/Center
  • Magee, MS
  • NPI 1750895611

  MS

  Medicare reassignment Care Compare group NPD
• Magee Benevolent Association

  • Family Nurse Practitioner
  • Raleigh, MS
  • NPI 1225157258

  MS

  Medicare reassignment Care Compare group
• Covington County Hospital

  • Emergency Medical Services (Emergency Medicine) Physician
  • Raleigh, MS
  • NPI 1003654567
  Care Compare group NPD
• Magee Benevolent Association

  • General Acute Care Hospital
  • Magee, MS
  • NPI 1679553994
  Care Compare group NPD
• Covington County Hospital

  • Rural Health Clinic/Center
  • Collins, MS
  • NPI 1013205350
  Care Compare group
• Covington County Hospital

  • Rural Acute Care Hospital
  • Raleigh, MS
  • NPI 1043051543
  Care Compare group
• Covington County Hospital

  • Skilled Nursing Facility
  • Collins, MS
  • NPI 1053615518
  Care Compare group

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

• Covington County Hospital

  • Critical Access Hospital
  • Collins, MS
  • NPI 1215965249

  Hospital

  Care Compare affiliation
• Magee Benevolent Association

  • General Acute Care Hospital
  • Magee, MS
  • NPI 1679553994

  Hospital

  Care Compare affiliation
• Sta-Home Health Agency of Jackson, Inc.

  • Home Health Agency
  • Clinton, MS
  • NPI 1356482749
  Care Compare affiliation

Specialty

Physician Assistant

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Magee Benevolent Association 19 clinicians

Covington County Hospital 44 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sta Home Health Agency of Jackson, Inc. Dba Accentcare Home Health of Jackson Home health agency, Clinton, MS, CCN 257102
• Covington County Hospital Cah Hospital, Collins, MS, CCN 251325
• Magee General Hospital Hospital, Magee, MS, CCN 250124

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577059200000",
    "number": "1962619932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 769",
            "city": "MAGEE",
            "state": "MS",
            "postal_code": "391110769",
            "telephone_number": "601-849-1475",
            "fax_number": "601-849-1549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "376A SIMPSON HIGHWAY 149",
            "city": "MAGEE",
            "state": "MS",
            "postal_code": "391113409",
            "telephone_number": "601-849-1475",
            "fax_number": "601-849-1549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DAVID",
        "middle_name": "SHANE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MS",
            "license": "PA024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00125918",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Megan Hollingsworth
• Hometown Healthcare of Magee, PLLC
• Hospice Providers, LLC
• Independent Healthcare Management Inc
• Rosalind Jaynes, RN
• Charlene William Jones-Smith, MS, CCC-SLP
• Kacey Jones, NP
• Karen M Bruce MD PLLC
• Kathleen Patterson, PHD, PLLC
• Terri Jean Keyes, D.C.

• All providers in Magee, MS
• Physician Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 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.
• 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.

Verify at the official NPI Registry.