NPIMap

Individual provider Active NPI

Stefan Johnson, MD

  • Diagnostic Radiology Physician
  • Cleveland, OH
National Provider Identifier
1063875177
Registry record updated Jul 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
35.141453 Issued in OH
Practice address
9500 Euclid Ave
Cleveland, OH 44195-0001
Phone
(216) 448-0218
NPI assigned
Apr 5, 2016
Last updated
Jul 8, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Diagnostic Radiology Physician 2085R0202X 35.141453 OH Primary
Diagnostic Radiology Physician 2085R0202X 310010-01 NY

Addresses

Primary practice location

9500 Euclid Ave
Cleveland, OH 44195-0001

Mailing address

9500 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 448-0218

Other practice location 1

1425 Portland Ave
Diagnostic Radiology
Rochester, NY 14621
Phone (585) 922-0881

Other practice location 2

2301 Holmes St
Kansas City, MO 64108-2640
Phone (816) 404-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20220707002705 NY Practitioner - Diagnostic Radiology 0143514679 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Kansas School of Med (KC/Wich/Sal), 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
United Memorial Medical CenterGroup PAC ID 0547259376, 271 clinicians
Rochester General HospitalGroup PAC ID 0244149474, 1,192 clinicians
The Unity Hospital of RochesterGroup PAC ID 9436060969, 732 clinicians
Clifton Springs Sanitarium CoGroup PAC ID 5092704809, 230 clinicians

Practice addresses (Care Compare)

100 Cross Keys Office Park
Suite 170
Fairport, NY 14450-3509
Phone (585) 223-1945

127 N St
Batavia, NY 14020-1631
Phone (585) 344-5449

1425 Portland Ave
Rochester, NY 14621-3001
Phone (585) 922-4000

1555 Long Pond Rd
Rochester, NY 14626-4122
Phone (585) 723-4000

2 Coulter Rd
Clifton Springs, NY 14432-1122
Phone (315) 462-5711

833 Canandaigua Rd
Geneva, NY 14456-2015
Phone (315) 210-1337

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.62 of 100Reported as apm
Quality
74.51
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
96.62 of 100Reported as apm
Quality
74.51
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
96.62 of 100Reported as apm
Quality
74.51
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
96.62 of 100Reported as apm
Quality
74.51
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
310010NYMDLicensed Practical Nurse
310010-01NYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Western New York Medical Practice P.C. CurrentSince Jun 1, 2022 Accepting new patients
Rochester General Hospital CurrentSince Jun 1, 2022 Accepting new patients
Rochester General Hospital Current Accepting new patients
Clifton Springs Sanitarium Co CurrentSince Oct 22, 2025 Accepting new patients
The Unity Hospital of Rochester CurrentSince Jun 1, 2022 Accepting new patients
United Memorial Medical Center CurrentSince Jun 1, 2022 Accepting new patients
The Unity Hospital of Rochester Current Accepting new patients
Rochester General Hospital CurrentSince Jun 1, 2022 Accepting new patients
Western New York Medical Practice, P.C. CurrentSince Jun 1, 2022 Accepting new patients
United Memorial Medical Center Current Accepting new patients

Locations

127 North St
Batavia, NY 14020
Phone (585) 267-7510

229 Summit St
Ste 1
Batavia, NY 14020
Phone (585) 343-4440

2 Coulter Rd
Clifton Springs, NY 14432
Phone (315) 462-1472

100 Cross Keys Office Park
Ste 170
Fairport, NY 14450
Phone (585) 223-1945

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

1555 Long Pond Rd
Rochester, NY 14626
Phone (585) 429-2289

Organizations & group practices 10

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625702400000",
    "number": "1063875177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441950001",
            "telephone_number": "216-448-0218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441950001",
            "telephone_number": "216-448-0218"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1425 Portland Ave",
            "address_2": "Diagnostic Radiology",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "14621",
            "country_code": "US",
            "telephone_number": "585-922-0881",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2301 Holmes St",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641082640",
            "country_code": "US",
            "telephone_number": "816-404-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "STEFAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-05",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "35.141453",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "310010-01",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.