Individual provider Active NPI

Daniel Brian Johnson, NP

  • Family Nurse Practitioner
  • Iron Mountain, MI
National Provider Identifier
1023477056
Registry record updated Mar 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704241201 Issued in MI
Practice address
440 Woodward Ave
Iron Mountain, MI 49801-4631
Phone
(906) 776-9040
Fax
(906) 774-7279
NPI assigned
Feb 18, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 4704241201 MI
Family Nurse Practitioner 363LF0000X 4704241201 MI Primary

Addresses

Primary practice location

440 Woodward Ave
Iron Mountain, MI 49801-4631

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160412002459 MI Practitioner - Nurse Practitioner 9638477482 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704241201MIMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Oconto Hospital & Medical Center, Inc. CurrentSince Nov 14, 2016 Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Nov 14, 2016 Accepting new patients

Locations

106 S School Rd
Daggett, MI 49821
Phone (906) 753-2155

1100 10th St
Menominee, MI 49858
Phone (906) 863-2256

Interoperability endpoints

  • Direct secure messaging: djohnson170837@direct.thedacare.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1455753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457308800000",
    "number": "1023477056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 WOODWARD AVE",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498014631",
            "telephone_number": "906-776-9040",
            "fax_number": "906-774-7279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DANIEL",
        "middle_name": "BRIAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-18",
        "last_updated": "2016-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704241201",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704241201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Iron Mountain, MI

Sources for this page

Verify at the official NPI Registry.