Individual provider Active NPI

Emily Johnson, M.D.

  • Neurology Physician
  • Grand Rapids, MI
National Provider Identifier
1023374048
Registry record updated Aug 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
4301108928 Issued in MI
Practice address
220 Cherry St SE
Grand Rapids, MI 49503-4608
Phone
(616) 685-5050
Fax
(616) 685-8962
NPI assigned
Apr 3, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Neurology Physician 2084N0400X 4301108928 MI Primary

Addresses

Primary practice location

220 Cherry St SE
Grand Rapids, MI 49503-4608

Mailing address

1900 44TH St SE
Kentwood, MI 49508-5008
Phone (616) 685-1808

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160816001480 MI Practitioner - Neurology 1052614542 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Wayne State University School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Health Partners - Physician SpecialistGroup PAC ID 2163572991, 66 clinicians

Practice addresses (Care Compare)

1500 E Sherman Blvd
Muskegon, MI 49444-1849
Phone (231) 672-3027

245 Cherry St SE
Suite 200
Grand Rapids, MI 49503-4607
Phone (616) 685-6330

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary'S Medical Group CurrentSince Aug 15, 2016 Accepting new patients
Advantage Health/Saint Mary'S Medical Group CurrentSince Aug 15, 2016 Accepting new patients
Mercy Health Partners - Physician Specialist CurrentSince Nov 15, 2019 Accepting new patients
Advantage Health Saint Mary'S Medical Group Past Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

220 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 685-5576

245 Cherry St SE
Ste 200
Grand Rapids, MI 49503
Phone (616) 685-3330

1500 E Sherman Blvd
Muskegon, MI 49444
Phone (231) 672-3027

Interoperability endpoints

  • Direct secure messaging: ejohnson36250@direct.trinity-health.org
  • Direct secure messaging: ejohnson104251@direct.covenanthealthcare.com

Organizations & group practices 4

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471219200000",
    "number": "1023374048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 44TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495085008",
            "telephone_number": "616-685-1808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 CHERRY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034608",
            "telephone_number": "616-685-5050",
            "fax_number": "616-685-8962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "EMILY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-03",
        "last_updated": "2016-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301108928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.