Active NPI
Gbemisola Oluwakemi Johnson, MD
- Family Medicine Physician
- Bolivar, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2025046442
- Practice address
- 3817 S. Springfield Avenue, Bolivar, Mo 6561
Suite 140
Bolivar, MO 65613 - Phone
- (417) 422-4769
- NPI assigned
- Mar 30, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2025046442 | MO | Primary |
Addresses
Primary practice location
3817 S. Springfield Avenue, Bolivar, Mo 6561
Suite 140
Bolivar, MO 65613
Mailing address
10901 Brighton Bay Blvd NE Apt 10209
St Petersburg, FL 33716-3459
Phone (757) 714-2331
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Clinic Springfield Communities
Practice addresses (Care Compare)
3817 S Springfield Ave
Sgfmc Bolivar Multi Specialty
Bolivar, MO 65613-9129
Phone (417) 820-3911
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2025046442 | MO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Clinic Springfield Communities | Family Medicine | Current | Accepting new patients |
| Mercy Clinic Springfield Communities | Family Medicine | Current | Accepting new patients |
| Mercy Clinic Springfield Communities | Family Medicine | Current | Accepting new patients |
Locations
3817 S Springfield Ave
Bolivar, MO 65613
Phone (417) 422-4769
3817 S Springfield Ave
Ste 140
Bolivar, MO 65613
Phone (417) 422-4769
1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379
1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379
2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905
Networks
- devoted network organization-27eb9117-6975-449a-a7ad-909243995ddc
- IL PPO Downstate
- IA HMO
- devoted network organization-2b183dd2-4e80-4977-80a6-4fdf0df4361d
- IA HMO C-SNP
- devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9
Interoperability endpoints
- gbemisola.johnson@hca4.eclinicaldirectplus.com
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Springfield, MO
- NPI 1245277631
-
- Rural Health Clinic/Center
- Willow Springs, MO
- NPI 1972771657
Family Medicine
-
- Family Medicine Physician
- Hollister, MO
- NPI 1053350454
Hospital & facility affiliations 9
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Springfield, MO
- NPI 1578504056
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761264000000",
"number": "1003556903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10901 BRIGHTON BAY BLVD NE APT 10209",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337163459",
"telephone_number": "757-714-2331",
"fax_number": "727-341-4886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3817 S. SPRINGFIELD AVENUE, BOLIVAR, MO 6561",
"address_2": "SUITE 140",
"city": "BOLIVAR",
"state": "MO",
"postal_code": "65613",
"telephone_number": "417-422-4769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "GBEMISOLA",
"middle_name": "OLUWAKEMI",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-30",
"last_updated": "2025-10-24",
"certification_date": "2025-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "2025046442",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bolivar, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.