Jack Frank Johnson III, APRN

Primary specialty

Pediatric Clinical Nurse SpecialistTaxonomy code 364SP0200X

License

3360 Issued in SC

Practice address

724 Arden LN
Suite 100
Rock Hill, SC 29732-2996

Phone

(803) 980-7337

Fax

(803) 980-2229

NPI assigned

Jun 4, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mr. Jay Johnson III Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Interoperability endpoints

• Direct secure messaging: jackjohnson@chapinpedi.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.

• Sunshine Pediatrics

  • Pediatrics Physician
  • Rock Hill, SC
  • NPI 1629169693
  NPD (past)
• Sweetgrass Pediatrics

  • Pediatrics Physician
  • North Charleston, SC
  • NPI 1437168135
  NPD (past)

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

{
    "created_epoch": "1244073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244073600000",
    "number": "1962638999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 ARDEN LN",
            "address_2": "SUITE 100",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297322996",
            "telephone_number": "803-980-7337",
            "fax_number": "803-980-2229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 ARDEN LN",
            "address_2": "SUITE 100",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297322996",
            "telephone_number": "803-980-7337",
            "fax_number": "803-980-2229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACK",
        "middle_name": "FRANK",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-04",
        "last_updated": "2009-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Pediatrics",
            "state": "SC",
            "license": "3360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTH CAROLINA STATE LICENSE",
            "identifier": "3360",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTH CAROLINA CONTROLLED SUBSTANCES CERTIFICATE OF REGISTRATION",
            "identifier": "54-03360",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAY",
            "last_name": "JOHNSON",
            "prefix": "MR.",
            "suffix": "III",
            "credential": "APRN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Doretta Johnson, CNA
• Emily Louise Johnson, MSW
• Eric Gordon Johnson, MD
• Erica Johnson, RN
• Heather Johnson, D.D.S.
• Jane Johnson
• Rashida Johnson
• Robin Johnson
• Sheena Johnson, PHARMD
• Tracey L Johnson, L.I.S.W.-CP

• Pediatric Clinical Nurse Specialist in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• Pediatric Clinical Nurse Specialist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.