Dr Stephen Kennedy Johnson, MD, PHD is a medicare enrolled "Pediatrics" provider in Louisville, Kentucky. His current practice location is
10211 Westport Rd, Louisville, Kentucky. You can reach out to his office (for appointments etc.) via phone at
(502) 339-0444.
Dr Stephen Kennedy Johnson is licensed to practice in Kentucky (license number 46857) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1417155953.
Healthcare Provider's Profile
| Full Name | Dr Stephen Kennedy Johnson |
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| Gender | Male |
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| Speciality | Pediatrics |
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| Location | 10211 Westport Rd, Louisville, Kentucky |
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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: 1417155953
- Provider Enumeration Date: 07/05/2007
- Last Update Date: 04/13/2021
Medicare PECOS Information:
- PECOS PAC ID: 8123066933
- Enrollment ID: I20140801001538
Medical Identifiers
Medical identifiers for Dr Stephen Kennedy Johnson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1417155953 | NPI | - | NPPES |
| 50079132 | Other | KY | PASSPORT-NCMA |
| 000000885933 | Other | KY | ANTHEM-NCMA |
| 165151 | Other | KY | SIHO-NCMA |
| 7100215230 | Medicaid | KY | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103TC0700X | Psychologist - Clinical | 1376 (Kentucky) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | 46857 (Kentucky) | 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. Dr Stephen Kennedy Johnson allows following entities to bill medicare on his behalf.
| Entity Name | Community Medical Associates Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1306983762
PECOS PAC ID: 7012811284
Enrollment ID: O20031120000656 |
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| Entity Name | Norton Childrens Medical Group Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1457999096
PECOS PAC ID: 3779917596
Enrollment ID: O20200102000758 |
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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. Dr Stephen Kennedy 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 |
|---|
Dr Stephen Kennedy Johnson, MD, PHD
Po Box 776879,
Chicago, IL 60677-6879
Ph: (502) 272-5395 | Dr Stephen Kennedy Johnson, MD, PHD
10211 Westport Rd,
Louisville, KY 40241-2147
Ph: (502) 339-0444 |
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