Kimberly Johnson, RD is a medicare enrolled "Dietitian, Registered" provider in Lauderdale By The Sea, Florida. Her current practice location is
4213 El Mar Dr Apt 4, Lauderdale By The Sea, Florida. You can reach out to her office (for appointments etc.) via phone at
(918) 630-1578.
Kimberly Johnson is licensed to practice in Florida (license number 10842) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1114665395.
Healthcare Provider's Profile
| Full Name | Kimberly Johnson |
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| Gender | Female |
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| Speciality | Dietitian, Registered |
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| Location | 4213 El Mar Dr Apt 4, Lauderdale By The Sea, Florida |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1114665395
- Provider Enumeration Date: 05/26/2022
- Last Update Date: 06/06/2022
Medicare PECOS Information:
- PECOS PAC ID: 0749644300
- Enrollment ID: I20230914002680
Medical Identifiers
Medical identifiers for Kimberly Johnson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1114665395 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 133V00000X | Dietitian, Registered | 10842 (Florida) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kimberly Johnson allows following entities to bill medicare on her behalf.
| Provider Name | Dietitian Group Corporation |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1093312381
PECOS PAC ID: 7416363452
Enrollment ID: O20210317000564 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kimberly Johnson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Kimberly Johnson, RD
4213 El Mar Dr Apt 4,
Lauderdale By The Sea, FL 33308-5420
Ph: (918) 630-1578 | Kimberly Johnson, RD
4213 El Mar Dr Apt 4,
Lauderdale By The Sea, FL 33308-5420
Ph: (918) 630-1578 |
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