Active NPI
Jade Taylir Johnson, ATC
- Sports Medicine (Preventive Medicine) Physician
- Wayne, NE
National Provider Identifier
1073083457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Preventive Medicine) Physician
- License
- 777
- Practice address
- 1111 Main St
Wayne, NE 68787-1181 - Phone
- (402) 375-7162
- NPI assigned
- Nov 28, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 777 | NE | |
| Sports Medicine (Preventive Medicine) Physician | 2083S0010X | 777 | NE | Primary |
Addresses
Primary practice location
1111 Main St
Wayne, NE 68787-1181
Mailing address
521 E 6TH St
Wayne, NE 68787-2210
Phone (715) 566-3288
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 777 | NE | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1543363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543363200000",
"number": "1073083457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "521 E 6TH ST",
"city": "WAYNE",
"state": "NE",
"postal_code": "687872210",
"telephone_number": "715-566-3288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 MAIN ST",
"city": "WAYNE",
"state": "NE",
"postal_code": "687871181",
"telephone_number": "402-375-7162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JADE",
"middle_name": "TAYLIR",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-28",
"last_updated": "2018-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "NE",
"license": "777",
"primary": false
},
{
"code": "2083S0010X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Sports Medicine",
"state": "NE",
"license": "777",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wayne, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.