JERRY C JOHNSON (NPI# 1669415972) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669415972 |
| Entity Type | Individual |
| Full Name | JERRY C JOHNSON |
| Credential | MD |
| Practice Address |
3615 Chestnut St Ralston Penn Center Philadelphia PA 19104 |
| Mailing Address |
3615 Chestnut St Ralston Penn Center Philadelphia PA 19104-2612 |
| Practice Telephone | 2156622746 |
| Practice Fax Number | 2153495648 |
| Mailing Telephone | 2156622746 |
| Mailing Fax Number | 2153495648 |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2012-03-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | MD019829E | PA | Allopathic & Osteopathic Physicians |
| Y | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
MD019829E | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 0007361000007 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629454897 | Jerry Johnson | Pharmacist | 4004 Lake Adger Pkwy, Mill Spring, NC 28756-4800 | 2015-08-10 |
| 1487721858 | Jerry L Johnson | Obstetrics & Gynecology | 503 S John Redditt Dr, Lufkin, TX 75904-3120 | 2006-11-29 |
| 1730260829 | Jerry Lee Johnson | Chiropractor | 11914 N Pennsylvania Ave Ste B3, Oklahoma City, OK 73120-7831 | 2006-10-17 |
| 1780779140 | Jerry Allen Johnson | Physician Assistant | 1201 Sam Bass Road, Round Rock, TX 78681-4137 | 2006-10-03 |
| 1003907817 | Jerry Lee Johnson | Chiropractor | 4312 Mormon Coulee Rd, La Crosse, WI 54601-7908 | 2006-09-27 |
| 1346253499 | Jerry N Johnson | Chiropractor | 1502 E Belt Line Rd, Carrollton, TX 75006-6307 | 2006-08-13 |
| 1316975568 | Jerry Lee Johnson | Dentist | 1316 Mcmillan St, Worthington, MN 56187-1646 | 2006-06-28 |
| 1871584565 | Jerry Alan Johnson | Dentist | 2295 E Washington Blvd, Pasadena, CA 91104-1944 | 2005-11-02 |
| 1952305351 | Jerry H Johnson | Dentist | 1277 Highway 411, Vonore, TN 37885-2456 | 2005-06-13 |
| 1962057802 | Jerry Michael Johnson | Pharmacist | 311 S Avenue D, Burkburnett, TX 76354-3541 | 2019-08-07 |
| Street Address |
3615 CHESTNUT ST RALSTON PENN CENTER |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548243751 | Lisa Maria Walke | Internal Medicine | 3615 Chestnut St, Philadelphia, PA 19104 | 2005-11-22 |
| 1972028140 | Shannon Mone Eimer | Nurse Practitioner | 3615 Chestnut St, Philadelphia, PA 19104 | 2017-08-09 |
| 1952853319 | Laura Pendleton Okami | Nurse Practitioner | 3615 Chestnut St, Philadelphia, PA 19104-2612 | 2016-11-01 |
| 1104274703 | Mariana R Gonzalez | Internal Medicine | 3615 Chestnut St, Philadelphia, PA 19104-2612 | 2016-05-25 |
| 1164879862 | Hishen Dang | Family Medicine | 3615 Chestnut St, Philadelphia, PA 19104-2612 | 2016-05-23 |
| 1649636317 | Jennifer Giddings | Nurse Practitioner | 3615 Chestnut St, Philadelphia, PA 19104-2612 | 2016-01-11 |
| 1649667684 | Alyson Michener | Internal Medicine | 3615 Chestnut St, Philadelphia, PA 19104-2612 | 2015-04-16 |
| 1528476454 | Linda J Schreiber Williams | Nurse Practitioner | 3615 Chestnut St, Rm 348, Philadelphia, PA 19104-2612 | 2014-07-23 |
| 1407288376 | Kathy Marie Witta | Nurse Practitioner | 3615 Chestnut St, Ralston Penn Center, Philadelphia, PA 19104-2612 | 2013-08-02 |
| 1205272499 | Alysa Beth Krain | Internal Medicine | 3615 Chestnut St, Ralston Penn Center, Philadelphia, PA 19104-2612 | 2013-05-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639770829 | Michelle Morris | Student in an Organized Health Care Education/Training Program | Dept. of Family Medicine & Community Health, 3737 Market, Philadelphia, PA 19104 | 2020-11-04 |
| 1346853041 | Spectrum Health Services, Inc. | Clinic/Center | 1415 South University Ave, Philadelphia, PA 19104 | 2020-08-24 |
| 1770104259 | Fatimah Sorefan-mangou | Student in an Organized Health Care Education/Training Program | 4 Maloney 3400 Spruce Street, Philadelphia, PA 19104 | 2020-05-06 |
| 1114548690 | Rebecca Blaguski | Registered Nurse | The Hospital of The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 | 2020-05-06 |
| 1952944175 | Rebecca Miriam Barmherzig | Psychiatry & Neurology | 3501 Civic Centre Blvd, 10th Flr Ctrb, Neurology, Philadelphia, PA 19104 | 2019-10-21 |
| 1891257101 | James Paul Byrne | Surgery | Penn Presbyterian Medical Center, Division of Trauma, S, 51 N. 39th Street, Suite 120, 1st Floor Medical Office, Philadelphia, PA 19104 | 2019-04-04 |
| 1093276453 | Lauren Shreve | Student in an Organized Health Care Education/Training Program | Department of Surgery, Surgery Education - Penn Health, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104 | 2019-03-28 |
| 1285194282 | Lauren M Christie | Student in an Organized Health Care Education/Training Program | Penn Presbyterian Medical Center, 51 N. 39th Street, Philadelphia, PA 19104 | 2019-03-25 |
| 1114487683 | Sabrina Layne | Student in an Organized Health Care Education/Training Program | 3400 Spruce Street, 100 Centrex, Philadelphia, PA 19104 | 2019-03-21 |
| 1811457310 | Kia Lor | Student in an Organized Health Care Education/Training Program | Hospital of University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104 | 2019-03-21 |
| Find all providers in zip 19104 | ||||
| Taxonomy Code | 207RG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Geriatric Medicine |
| An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730239039 | Chintana Suanlarm | Internal Medicine | 5129 Germantown Ave, Philadelphia, PA 19144-2326 | 2007-01-11 |
| 1548338874 | Alan P Berg | Internal Medicine | 1940 W Allegheny Ave, Philadelphia, PA 19132-1614 | 2006-12-04 |
| 1689748600 | Richard Gebriel Stefanacci | Internal Medicine | 600 S 43rd St, Philadelphia, PA 19104-4418 | 2006-11-20 |
| 1962513531 | Maria Fogata, M.d., PC | Internal Medicine | 7800 Bustelton Ave, Philadelphia, PA 19152 | 2006-08-31 |
| 1093724890 | Joel Sam Betesh | Internal Medicine | 2240 S 3rd St Fl 2, Philadelphia, PA 19148-3347 | 2006-08-08 |
| 1346257490 | Luz S Ramos-bonner | Internal Medicine | 6970 Germantown Ave, Philadelphia, PA 19119-2114 | 2006-08-02 |
| 1275584807 | Ellen N Zagrebelsky | Internal Medicine | 9892 Bustleton Ave, Suite 102, Philadelphia, PA 19115-2184 | 2006-05-16 |
| 1962465674 | Heidi J Syropoulos | Internal Medicine | 1010 W Lehigh Ave, Philadelphia, PA 19133-1640 | 2006-04-11 |
| 1548243751 | Lisa Maria Walke | Internal Medicine | 3615 Chestnut St, Philadelphia, PA 19104 | 2005-11-22 |
| 1457340317 | Emmanuel C Okolo | Internal Medicine | 6950 Germantown Ave, Philadelphia, PA 19119-2120 | 2005-10-13 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.