NPIMap

Individual provider Active NPI

David Shane Johnson, PA-C

  • Physician Assistant
  • Magee, MS
National Provider Identifier
1962619932
Registry record updated Dec 23, 2019
On this page

Key facts

NPPES NPI Registry
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
Last updated
Dec 23, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA024 MS Primary

Addresses

Primary practice location

376A Simpson Highway 149
Magee, MS 39111-3409

Mailing address

PO Box 769
Magee, MS 39111-0769
Phone (601) 849-1475

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20041203000641 MS Practitioner - Physician Assistant 9436115292 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Magee Benevolent AssociationGroup PAC ID 3678466463, 19 clinicians
Covington County HospitalGroup PAC ID 4183517253, shared by 16 NPIs, 44 clinicians

Practice addresses (Care Compare)

300 3Rd Ave SE
Magee, MS 39111-3665
Phone (601) 849-5070

300 3Rd Ave SE Northwing
Magee, MS 39111-3665
Phone (601) 849-7702

800 3Rd St SW
Magee, MS 39111-3951
Phone (601) 849-1918

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA024MSMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Covington County Hospital CurrentSince Aug 25, 2025 Accepting new patients
Covington County Hospital CurrentSince Aug 25, 2025 Accepting new patients
Covington County Hospital CurrentSince Aug 25, 2025 Accepting new patients
Covington County Hospital CurrentSince Aug 25, 2025 Accepting new patients
South Central Regional Medical Center CurrentSince Jul 1, 2011 Accepting new patients
Thomas R. Blackledge, Jr., MD, PA Current Accepting new patients
Covington County Hospital CurrentSince Aug 25, 2025 Accepting new patients
Covington County Hospital CurrentSince Aug 25, 2025 Accepting new patients
South Central Regional Medical Center CurrentSince Jul 1, 2011 Accepting new patients
Covington County Hospital CurrentSince Aug 25, 2025 Accepting new patients
Green Tree Family Medical Clinic Current Accepting new patients
Magee After Hours Clinic PLLC Physician Assistant Past Accepting new patients
Magee Benevolent Assn Dba Pediatric Clinic of Magee Past Accepting new patients

Locations

3275 Highway 49
Ste E
Collins, MS 39428
Phone (601) 765-6292

300 SE 3rd Ave
Magee, MS 39111
Phone (601) 849-5070

360 Simpson Highway 149
Ste 150
Magee, MS 39111
Phone (601) 721-1828

800 3rd St SW
Magee, MS 39111
Phone (601) 849-1918

105 Eaton St
Taylorsville, MS 39168
Phone (601) 452-4280

Interoperability endpoints

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

Organizations & group practices 14

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.

View all 14

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

Other providers in Magee, MS

Sources for this page

Verify at the official NPI Registry.