DR. WALTER KIP JOHNSON (M.D.) – Family Medicine Physician, NPI 1780919282
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,034 GENERAL PRACTICE in CA
Provider Addresses for DR. WALTER KIP JOHNSON (M.D.)
12140 New York Ranch Rd
Jackson, CA 956429407
Phone: (209) 257-2400
Fax: (209) 257-2403
Type: Location
PO BOX 605
MURRIETA, CA 925640605
Phone: (949) 275-4658
Type: Mailing
23532, Mountain Breeze Drive, Murrieta, Riverside County, California, 92562, United States
MURRIETA, CA 925625037
Phone: (949) 275-4658
Type: Location
PO BOX 939
ANGELS CAMP, CA 952220939
Phone: (209) 754-6262
Fax: (209) 754-6275
Type: Mailing
305 PRESTON AVE
IONE, CA 956409158
Phone: (209) 742-6144
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $173.
Total Amount is formed as General ($173) + Research ($0) + Ownership ($0) = $173.
Last reported payment date: 2024-11-05 • Largest payer in this snapshot: Abbott Laboratories ($149).
Total Amount
$173
General + Research + Ownership
Payments
2
Total payment records
General Amount
$173
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-05
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Abbott Laboratories | $149 |
| Hologic Sales and Service, LLC | $24 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-11-27
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20091222000598 | I | General Practice | CA | TBD |
| I20241127002649 | I | General Practice | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 95642)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| P S Y C H I A T R Y | CA | |
| Nurse Practitioner | CA | |
| C H I R O P R A C T I C | ID | |
| Nurse Practitioner | CA | |
| Physician Assistant | CA | |
| C H I R O P R A C T I C | CA | |
| General Practice, Internal Medicine, Internal Medicine | CA | |
| General Practice, Family Practice, Family Practice, Internal Medicine | CA | |
| P S Y C H I A T R Y | CA | |
| Clinical Social Worker | CA |
Reviews
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