Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1841379187 Individual Practitioner Male Practitioner

Dr. Dwayne Edward Johnson , MD

Pediatrics • Elkhart, IN

Professional Overview & Biography Verified Profile Summary

Dr. Dwayne Johnson, MD is a certified Pediatrics practicing in Elkhart, IN. With approximately 43 years of clinical experience since graduating from University Of Kentucky College Of Medicine in 1983, Dr. Johnson delivers high-quality medical care to the local community at 236 SIMPSON AVE.

Dr. Johnson does not directly accept Medicare assignment.

Practice Location & Contact Primary Location

Practice Address

236 Simpson Ave

Elkhart, IN 465164666

Telephone 5745847373
Fax 5742933744
Associated Practice Facility / Clinic

Medicare Profile & Education

Medical School

University Of Kentucky College Of Medicine

Graduation Year

1983

Medicare Assignment

Not Specified

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Pediatrics in Elkhart, IN

Senior Veteran Specialist (>20 Yrs)
Practitioner Clinical Experience
43 Yrs +22.6 yrs vs City Avg
City Avg: 20.4 Yrs
State Avg: 19.8 Yrs
Regional Practice Density
19 Specialists

Practicing in Elkhart, IN (1179 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Johnson (43 Years) 43 Yrs
Elkhart Specialty Average (20.4 Years) 20.4 Yrs

Medical Specialties & State Licenses

CMS Verified: 2023-11-03
Pediatrics Primary Specialty

NUCC Taxonomy Code: 208000000X

State License IN 01073977A

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Pediatrics

NUCC Taxonomy Code: 208000000X

State License KY 28666

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
200287610B (IN)
Medicaid State Provider ID
642886669 (KY)
Commercial Insurance / Payer ID Pponext
611336483
Commercial Insurance / Payer ID United Healthcare
611336483
Commercial Insurance / Payer ID Passport Advantage
2435769000
Commercial Insurance / Payer ID Humana Health Plan, Inc.
611336483
Commercial Insurance / Payer ID Passport Health Plan
1087687
Commercial Insurance / Payer ID Preferred Health Plan
611336483
Commercial Insurance / Payer ID Anthem
000000052119
Commercial Insurance / Payer ID Aetna
2133380

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners
Terrance Poindexter , LCSW

Social Worker - Clinical

NPI 1225441751

Licensed Clinical Social Worker

Dr. Martina Green-Mcgowan , MD

Obstetrics & Gynecology

NPI 1295739639

Doctor of Medicine (M.D.)

Andrea Miller , APN

Nurse Practitioner - Psychiatric/Mental Health

NPI 1508304304

Advanced Practice Nurse

NPI 1508959545

Doctor of Dental Surgery

Dr. James Jackson , DO

Family Medicine

NPI 1548251937

Doctor of Osteopathic Medicine (D.O.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events
NPI Profile Active March 08, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location March 08, 2017

Registered at 236 SIMPSON AVE, ELKHART, IN 465164666 (Tel: 5745847373)

📍
Updated Business Mailing Address March 08, 2017

Registered at 148 W HIVELY AVE, SUITE 1, ELKHART, IN 465172191 (Tel: 5743502500)

👤
Provider Name / Credentials Updated March 08, 2017

Recorded as DWAYNE JOHNSON, M.D.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 08, 2017

Pediatrics (License #01073977A in IN)

NPI Profile Active February 13, 2013

NPI status registered as active in NPPES database

📍
Updated Practice Location February 13, 2013

Registered at 2211 MEADOW DR, SUITE A, LOUISVILLE, KY 402181330 (Tel: 5024582577)

📍
Updated Business Mailing Address February 13, 2013

Registered at 2211 MEADOW DR, SUITE A, LOUISVILLE, KY 402181330 (Tel: 5024582577)

👤
Provider Name / Credentials Updated February 13, 2013

Recorded as DWAYNE JOHNSON, M.D.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) February 13, 2013

Pediatrics (License #28666 in KY)

🟢
Initial NPI Registration & Enumeration November 06, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1841379187
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 06, 2006
Last Update: November 03, 2023
Sole Proprietor: Yes

Mailing Address

148 W Hively Ave, Suite 1

Elkhart, IN 465172191

Phone: 5743502500

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.