Johnie Ray Staton III, PT
NPI 1114665528ActiveIndividual· Physical Therapist· Greenwood, IN
Physical Therapist (PT) with Privia Medical Group Tennessee LLC, practicing in Greenwood, Indiana. Medicare paid $6,469 for services to 20 patients in 2024.
Overview
| NPI | 1114665528 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PT |
| Sole proprietor | No |
| NPI issued | May 25, 2022 |
| Last updated in NPPES | May 25, 2022 |
| Certified by provider | May 25, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | 05014558A | IN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (TN) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 20 |
|---|---|
| Services billed | 313 across 8 procedure codes |
| Paid by Medicare | $6,469 |
Education and affiliations
| Graduation year | 2022 |
|---|---|
| Medicare specialty | Physical Therapist In Private Practice |
Medical group
- Privia Medical Group Tennessee LLCMt Juliet, TN · 140 clinicians
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