NPIMap

Individual provider Active NPI

Douglas Frederick Johnston, DO

  • Family Medicine Physician
  • Tyler, TX
National Provider Identifier
1083641559
Registry record updated Jan 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L7432 Issued in TX
Practice address
6210 S Broadway Ave
Tyler, TX 75703-4413
Phone
(903) 579-2700
Fax
(903) 534-9463
NPI assigned
Jun 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L7432 TX Primary

Addresses

Primary practice location

6210 S Broadway Ave
Tyler, TX 75703-4413

Mailing address

PO Box 9477
Tyler, TX 75711-9477
Phone (903) 594-2450

Other identifiers 2

IdentifierTypeStateIssuer
P00050031OtherMEDICARE RR
8J0326OtherTXBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20100215000764 TX Practitioner - Family Practice 6103830773 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Etmc Physician Group, Inc.Group PAC ID 4486915600, 375 clinicians

Practice addresses (Care Compare)

6210 S Broadway Ave
Tyler, TX 75703-4413
Phone (903) 579-2700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions11
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3399IAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Etmc Physician Group Inc. CurrentSince Mar 1, 2018 Accepting new patients
Etmc Physician Group Inc. CurrentSince Mar 1, 2018 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Starks Medical Past Accepting new patients

Locations

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

6210 S Broadway Ave
Tyler, TX 75703
Phone (903) 579-2700

1000 S Beckham Ave
Tyler, TX 75701
Phone (903) 526-1068

Interoperability endpoints

  • Direct secure messaging: djohnston355017@ahs.direct-ci.com

Organizations & group practices 4

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199318400000",
    "number": "1083641559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9477",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757119477",
            "telephone_number": "903-594-2450",
            "fax_number": "903-509-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6210 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757034413",
            "telephone_number": "903-579-2700",
            "fax_number": "903-534-9463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "DOUGLAS",
        "middle_name": "FREDERICK",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2008-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L7432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00050031",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8J0326",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.