Samuel Stuart Johnson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

6454773-1205 Issued in UT

Practice address

1058 College Dr
New Town, ND 58763-9112

Phone

(701) 627-4750

Fax

(888) 877-8471

NPI assigned

Aug 12, 2005

Last updated

May 8, 2015By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431043200000",
    "number": "1043212749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 MAIN ST # 676",
            "city": "NEW TOWN",
            "state": "ND",
            "postal_code": "587634000",
            "telephone_number": "385-414-1376",
            "fax_number": "888-877-8471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1058 COLLEGE DR",
            "city": "NEW TOWN",
            "state": "ND",
            "postal_code": "587639112",
            "telephone_number": "701-627-4750",
            "fax_number": "888-877-8471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SAMUEL",
        "middle_name": "STUART",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-12",
        "last_updated": "2015-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "6454773-1205",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "12967",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003763400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Delano R. Irwin, LCSW
• Jay Ann James
• Debbie Joyce Jeanotte, REGISTERED NURSE
• Lori A Jepson, NP
• James L Jeske, O.D.
• Jennifer Jordan, ARRT(R)
• Rebecca Kelly
• Robert Daniel Kifer, D.D.S.
• Betty Knight
• Julie Ann Laducer, APRN-CNP

• Family Medicine Physician in New Town, ND
• Providers in New Town, ND by specialty
• Family Medicine Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.