NPIMap

Individual provider Active NPI

Mark Christopher Johnson, M.D.

  • Diagnostic Radiology Physician
  • Des Moines, IA
National Provider Identifier
1053439059
Registry record updated Jul 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
39397 Issued in IA
Practice address
1111 6TH Ave
Des Moines, IA 50314-2613
Phone
(515) 643-2667
NPI assigned
Mar 27, 2007
Last updated
Jul 21, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 39397 IA Primary

Addresses

Primary practice location

1111 6TH Ave
Des Moines, IA 50314-2613

Mailing address

1111 6TH Ave
Des Moines, IA 50314-2613
Phone (515) 643-2667

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110722000433 IA Practitioner - Diagnostic Radiology 0244426807 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Iowa, RJ & L Carver College of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Diagnostic Imaging Associates, P.C.Group PAC ID 7113820788, 20 clinicians

Practice addresses (Care Compare)

1111 6TH Ave
Des Moines, IA 50314-2610

1111 6TH Ave
Des Moines, IA 50314-2613
Phone (515) 643-2667

1601 NW 114TH St
Suite 149
Clive, IA 50325-7046
Phone (515) 222-7550

1755 59TH PL
West Des Moines, IA 50266-7737
Phone (515) 358-8262

522 N Hancock St
Ottumwa, IA 52501-4231
Phone (515) 247-3130

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39397IAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Diagnostic Imaging Associates, P.C. Diagnostic Radiology CurrentSince Aug 1, 2011 Accepting new patients
Catholic Health Initiatives-Iowa Corp CurrentSince Oct 1, 2013 Accepting new patients
Catholic Health Initiatives-Iowa Corp CurrentSince Oct 1, 2013 Accepting new patients

Locations

1816 Philadelphia St
Ames, IA 50010
Phone (515) 232-2500

515 Pacific Ave
Audubon, IA 50025
Phone (712) 563-2611

1111 6th Ave
Des Moines, IA 50314
Phone (515) 247-3121

405 SW 5th St
Ste E
Des Moines, IA 50309
Phone (515) 358-7259

1301 W Main St
Lake City, IA 51449
Phone (712) 464-3171

1405 NW Church St
Leon, IA 50144
Phone (641) 446-2340

211 Highland Ave
Sac City, IA 50583
Phone (712) 662-7105

300 W Hutchings St
Winterset, IA 50273
Phone (515) 223-4368

Interoperability endpoints

  • Direct secure messaging: mjohnson3948657@direct.trinity-health.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311206400000",
    "number": "1053439059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 6TH AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503142613",
            "telephone_number": "515-643-2667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 6TH AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503142613",
            "telephone_number": "515-643-2667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARK",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2011-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IA",
            "license": "39397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.