MRS. KELLY JACKSON JOHNSON (PA-C) – Physician Assistant, NPI 1235412982
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MRS. KELLY JACKSON JOHNSON (PA-C)
4787 ALBEN BARKLEY DR
SUITE 103
PADUCAH, KY 420016789
Phone: (270) 442-9461
Fax: (270) 441-0079
Type: Mailing
510 LINCOLN DR
HERRIN, IL 629486334
Phone: (618) 997-6800
Fax: (618) 997-1187
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2011-10-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20111012000368 | I | Physician Assistant | KY | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 13 | 12 | $0 |
Insurance plans in this area (ZIP 42001)
Loading plans...
Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | IL | 73562 | X-ray of knee, 3 views | 19 | 14 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | IL | |
| - | IL | |
| Physician Assistant | IL | |
| Orthopedic Surgery | IL | |
| Orthopedic Surgery | IL | |
| - | IL | |
| Physical Therapist In Private Practice | IL | |
| - | IL | |
| Orthopedic Surgery | IL | |
| Physician Assistant | IL |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.