Mark Rolfe Johnson, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

184901-1205 Issued in UT

Practice address

32 W 200 S # 410
Salt Lake City, UT 84101-1603

Phone

(801) 960-4890

Fax

(801) 960-4890

NPI assigned

Aug 22, 2005

Last updated

Apr 23, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587600000000",
    "number": "1043202393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 PLEASANT VALLEY DR STE 210",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780065683",
            "telephone_number": "830-267-4575",
            "fax_number": "830-214-2576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 W 200 S # 410",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841011603",
            "telephone_number": "801-960-4890",
            "fax_number": "801-960-4890"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1899 E Siesta Dr",
            "address_purpose": "LOCATION",
            "city": "Sandy",
            "state": "UT",
            "postal_code": "840936241",
            "country_code": "US",
            "telephone_number": "801-631-8210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARK",
        "middle_name": "ROLFE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "184901-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1001176",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Ann Johnson
• Lorene S Johnson, A.P.R.N.
• Lynn Douglas Johnson, PH.D.
• Marissa Johnson, DO
• Mark Dale Johnson, MD
• Matthew Adam Johnson, RD
• Matthew H Johnson, MD
• Megan C Johnson
• Meghan N Johnson
• Melanie Kristine Johnson, B.S.

• Internal Medicine Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Internal Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.