Physician Compare National (NPI:1821096421)

HEALTHCARE PROVIDER: THOMAS DWAYNE JOHNSON MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1821096421
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3375595333
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050217000642
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JOHNSON
	Individual professional last name
Provider First Name	THOMAS
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	532 N BARDSTOWN RD
	Group Practice or individual's line 1 address
City	MT WASHINGTON
	Group Practice or individual's city
State	KY
	Group Practice or individual's state
Zip Code	400477642
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	180088
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORTON HOSPITALS, INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	180130
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BAPTIST HEALTH LOUISVILLE
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	181330
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	RUSSELL COUNTY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	180040
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	JEWISH HOSPITAL & ST MARY'S HEALTHCARE
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y