Kenneth Ray Johnson, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

6259 Issued in GA

Practice address

1203 Town Park LN
Evans, GA 30809

Phone

(706) 650-7546

Fax

(706) 922-9168

NPI assigned

Sep 19, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Physician Assistant

Education

Medical College of Georgia School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology Specialists of Augusta, IncGroup PAC ID 2668447988, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Augusta Hospital Hospital, Augusta, GA, CCN 110028

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: krjohnson@aadermaffiliates.emadirect.md
• Direct secure messaging: krjohnson@gaderm.emadirect.md

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.

• Dermatology Specialists of Augusta, Inc

  • Dermatology Physician
  • Evans, GA
  • NPI 1558339275
  Medicare reassignment Care Compare group

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

• University Health Services,Inc

  dba Piedmont Augusta Hospital

  • General Acute Care Hospital
  • Augusta, GA
  • NPI 1588665566
  Care Compare affiliation

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

{
    "created_epoch": "1316390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530230400000",
    "number": "1962784785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 63185",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282633001",
            "telephone_number": "706-650-7546",
            "fax_number": "706-922-9168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 TOWN PARK LN",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "30809",
            "telephone_number": "706-650-7546",
            "fax_number": "706-922-9168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENNETH",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-19",
        "last_updated": "2018-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "6259",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "6259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Jennings, NURSE PRACTITIONER
• Jacqueline Marie Jeschke, DPT
• Christopher Ryan Jimenez, MD
• Adeline Janine Johnson, M.D.
• Cameron Johnson
• Victor L Johnson, R.PH.
• William Kent Johnson, M.D.
• Laurie Denise Jolly
• Loretha Jones-Bell
• Hana Grace Jones, MHS, OTR/L

• Surgical Physician Assistant in Evans, GA
• Providers in Evans, GA by specialty
• Surgical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2018; 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.