Richard Owen Johnson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G29540 Issued in CA

Practice address

85 Sierra Park Road
Suite a
Mammoth Lakes, CA 93546

Phone

(760) 924-4000

Fax

(760) 924-4091

NPI assigned

Aug 21, 2006

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 CA

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

State licenses

Practice roles

Locations

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.

• County of Alpine

  • Public Health & General Preventive Medicine Physician
  • Markleeville, CA
  • NPI 1801070909

  CA

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366070400000",
    "number": "1063528362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660",
            "city": "MAMMOTH LAKES",
            "state": "CA",
            "postal_code": "935460660",
            "telephone_number": "760-924-4000",
            "fax_number": "760-924-4091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 SIERRA PARK ROAD",
            "address_2": "SUITE A",
            "city": "MAMMOTH LAKES",
            "state": "CA",
            "postal_code": "93546",
            "telephone_number": "760-924-4000",
            "fax_number": "760-924-4091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "RICHARD",
        "middle_name": "OWEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2013-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G29540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G295401",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shane Hennes
• Kyle Howell, M.D.
• Christopher Hummel, M.D.
• Intouch Microspa
• Nancy Ellen Johnson
• Michael Karch, M.D.
• Grace Charmie Kim, MD, MPP
• Kimdoc LLC
• Aleksandras Kirsonis, PHARMD
• Robert Kocher

• All providers in Mammoth Lakes, CA
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2013; 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.