Active NPI
Mary K Johnson
- Social Worker
- Omaha, NE
National Provider Identifier
1053471086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 2616
- Practice address
- 820 South 75TH Street
Omaha, NE 68114-4623 - Phone
- (402) 391-2477
- Fax
- (402) 397-4268
- NPI assigned
- Dec 11, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 2616 | NE | Primary |
Addresses
Primary practice location
820 South 75TH Street
Omaha, NE 68114-4623
Mailing address
820 South 75TH Street
Omaha, NE 68114-4623
Phone (402) 391-2477
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Sep 11, 2024 through Sep 11, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2616 | NE | MD | Critical Care Medicine (Internal Medicine) Physician |
| 2152 | NE | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sara Pattavina Moulton, Limhp, P.C. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Omaha, NE
- NPI 1447537220
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053471086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 SOUTH 75TH STREET",
"city": "OMAHA",
"state": "NE",
"postal_code": "681144623",
"telephone_number": "402-391-2477",
"fax_number": "402-397-4268"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 SOUTH 75TH STREET",
"city": "OMAHA",
"state": "NE",
"postal_code": "681144623",
"telephone_number": "402-391-2477",
"fax_number": "402-397-4268"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MARY",
"middle_name": "K",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NE",
"license": "2616",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.