Individual provider Active NPI

Lisa Monique Johnson, MD

  • Family Medicine Physician
  • Cincinnati, OH
National Provider Identifier
1073763306
Registry record updated Aug 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.091443 Issued in OH
Practice address
3120 Burnet Ave
Cincinnati, OH 45229-3091
Phone
(513) 584-8600
Fax
(513) 585-9018
NPI assigned
Sep 23, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent Medicine (Family Medicine) Physician 207QA0000X ME 101603 FL
Family Medicine Physician 207Q00000X 35.091443 OH Primary

Addresses

Primary practice location

3120 Burnet Ave
Cincinnati, OH 45229-3091

Mailing address

2830 Victory Parkway
Payor Enrollment
Cincinnati, OH 45206-1785
Phone (513) 585-5507

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, OH2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20121018000504 FL Practitioner - Family Practice 3779733290 Reassigns benefits to 1 organization
I20160912002510 OH Practitioner - Family Practice 3779733290 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME 101603FLMDAdolescent Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tallahassee Memorial Healthcare Inc Current Accepting new patients
Tallahassee Memorial Healthcare Inc. Family Medicine CurrentSince Oct 1, 2012 Accepting new patients
University of Cincinnati Physicians Company, LLC Family Medicine CurrentSince Sep 1, 2018 Accepting new patients
Tallahassee Memorial Healthcare Inc Family Medicine CurrentSince Oct 1, 2012 Accepting new patients
Children'S Hospital Medical Center CurrentSince Aug 11, 2016 Accepting new patients
Major Hospital Past Accepting new patients

Locations

178 Lefall Dr
Quincy, FL 32351
Phone (850) 875-3600

3341 Solutions Ctr
Chicago, IL 60677

3120 Burnet Ave
Ste 406
Cincinnati, OH 45229
Phone (513) 558-7700

2830 Victory Pkwy
Cincinnati, OH 45206
Phone (513) 245-3335

3333 Burnet Ave
Ste ML4000
Cincinnati, OH 45229

3333 Burnet Ave
#4000
Cincinnati, OH 45229
Phone (513) 636-4681

3333 Burnet Ave
Cincinnati, OH 45229
Phone (513) 636-4200

2123 Auburn Ave
#A28
Cincinnati, OH 45219
Phone (513) 585-0523

3188 Bellevue Ave
Cincinnati, OH 45219
Phone (513) 558-5281

3120 Burnet Ave
Cincinnati, OH 45229
Phone (513) 584-8600

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1222128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1073763306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2830 VICTORY PARKWAY",
            "address_2": "PAYOR ENROLLMENT",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452061785",
            "telephone_number": "513-585-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 BURNET AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293091",
            "telephone_number": "513-584-8600",
            "fax_number": "513-585-9018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "LISA",
        "middle_name": "MONIQUE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-23",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "FL",
            "license": "ME 101603",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.091443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.