Active NPI
Randy Phillip Johnson, MD
- Allergy Physician
- Santa Maria, CA
National Provider Identifier
1073671921
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy Physician
- License
- G62052
- Practice address
- 2151 S College Dr
Suite 105
Santa Maria, CA 93455-1302 - Phone
- (805) 922-6610
- Fax
- (805) 922-1226
- NPI assigned
- Dec 4, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Allergy Physician | 207KA0200X | G62052 | CA | Primary |
Addresses
Primary practice location
2151 S College Dr
Suite 105
Santa Maria, CA 93455-1302
Mailing address
2151 S College Dr
Suite 105
Santa Maria, CA 93455-1302
Phone (805) 922-6610
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100817000021 | CA | Practitioner - Allergy/Immunology | 4981738721 | Practice locations: Santa Maria, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52032 | CA | MD | Marriage & Family Therapist |
| G62052 | CA | MD | Allergy Physician |
Interoperability endpoints
- https://api.platform.athenahealth.com/9491/brand/1/csg/1/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284595200000",
"number": "1073671921",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2151 S COLLEGE DR",
"address_2": "SUITE 105",
"city": "SANTA MARIA",
"state": "CA",
"postal_code": "934551302",
"telephone_number": "805-922-6610",
"fax_number": "805-922-1226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2151 S COLLEGE DR",
"address_2": "SUITE 105",
"city": "SANTA MARIA",
"state": "CA",
"postal_code": "934551302",
"telephone_number": "805-922-6610",
"fax_number": "805-922-1226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "RANDY",
"middle_name": "PHILLIP",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-04",
"last_updated": "2010-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "207KA0200X",
"taxonomy_group": "",
"desc": "Allergy & Immunology, Allergy",
"state": "CA",
"license": "G62052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Maria, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; 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.