JERRY C JOHNSON MD NPI 1669415972

NPI Information

  • NPI: 1669415972
  • Provider Name: JERRY C JOHNSON, MD
  • Classification: Internal Medicine - 207RG0300X
  • Specialization: Geriatric Medicine
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 3615 CHESTNUT ST
    RALSTON PENN CENTER
    PHILADELPHIA, PA
    ZIP 19104
  • Phone: (215) 662-2746

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NPI Details

Jerry C Johnson, MD is a geriatric medicine internal medicine in Philadelphia, PA. The provider is 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. Jerry C Johnson, MD NPI is 1669415972. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3615 CHESTNUT ST
RALSTON PENN CENTER
PHILADELPHIA, PA
ZIP 19104
Phone: (215) 662-2746
Fax: (215) 349-5648

The NPI 1669415972 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/14/2006 and was last updated on 3/23/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207R00000XInternal MedicineMD019829EPENNSYLVANIANo
2207RG0300XInternal MedicineGeriatric MedicineMD019829EPENNSYLVANIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10007361000007MEDICAIDPENNSYLVANIA
2C28595MEDICARE UPIN
3058994MEDICARE PINPENNSYLVANIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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