Active NPI
Bert Jay Johns III, MD
- Surgery Physician
- Daly City, CA
National Provider Identifier
1053395848
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- G62546
- Practice address
- 1800 Sullivan Ave
Suite 507
Daly City, CA 94015-2225 - Phone
- (650) 994-9936
- Fax
- (650) 994-2016
- NPI assigned
- Dec 5, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | G62546 | CA | Primary |
Addresses
Primary practice location
1800 Sullivan Ave
Suite 507
Daly City, CA 94015-2225
Mailing address
1800 Sullivan Ave
Suite 507
Daly City, CA 94015-2225
Phone (650) 994-9936
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G625460 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G62546 | CA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240963200000",
"number": "1053395848",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 SULLIVAN AVE",
"address_2": "SUITE 507",
"city": "DALY CITY",
"state": "CA",
"postal_code": "940152225",
"telephone_number": "650-994-9936",
"fax_number": "650-994-2016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 SULLIVAN AVE",
"address_2": "SUITE 507",
"city": "DALY CITY",
"state": "CA",
"postal_code": "940152225",
"telephone_number": "650-994-9936",
"fax_number": "650-994-2016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNS",
"first_name": "BERT",
"middle_name": "JAY",
"name_suffix": "III",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-05",
"last_updated": "2009-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "G62546",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G625460",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Daly City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.