Active NPI
Gary Keith Johnson, M.D., M.P.H.
- Pediatrics Physician
- Flint, MI
National Provider Identifier
1083752802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 4301049794
- Practice address
- 630 S Saginaw St
Flint, MI 48502-1525 - Phone
- (810) 257-3155
- Fax
- (810) 257-3147
- NPI assigned
- Feb 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4301049794 | MI | Primary |
Addresses
Primary practice location
630 S Saginaw St
Flint, MI 48502-1525
Mailing address
630 S Saginaw St
Flint, MI 48502-1525
Phone (810) 257-3155
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3149584 | Medicaid | MI | |
| 3149593 | Medicaid | MI | |
| 2837685 | Medicaid | MI |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genesee County Health Department | Past | Accepting new patients | |
| County of Genesee Office of Controller | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Public Health or Welfare Agency
- Flint, MI
- NPI 1154370344
-
- Ambulatory Family Planning Facility
- Flint, MI
- NPI 1588963599
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1083752802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 S SAGINAW ST",
"city": "FLINT",
"state": "MI",
"postal_code": "485021525",
"telephone_number": "810-257-3155",
"fax_number": "810-257-3147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 S SAGINAW ST",
"city": "FLINT",
"state": "MI",
"postal_code": "485021525",
"telephone_number": "810-257-3155",
"fax_number": "810-257-3147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "GARY",
"middle_name": "KEITH",
"name_prefix": "Dr.",
"credential": "M.D., M.P.H.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4301049794",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3149584",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3149593",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2837685",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flint, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.