Active NPI
Debra A Johnsen, CNP
- Family Nurse Practitioner
- Cincinnati, OH
National Provider Identifier
1104874254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- NP-03967
- Practice address
- 3120 Burnet Ave
Cincinnati, OH 45229-3091 - Phone
- (513) 584-8600
- Fax
- (513) 584-8620
- NPI assigned
- May 4, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | NP-03967 | OH | Primary |
Addresses
Primary practice location
3120 Burnet Ave
Cincinnati, OH 45229-3091
Mailing address
PO Box 636256 Central Credentialing
Cincinnati, OH 45263-6256
Phone (513) 585-5501
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00194628 | Other | OH | RAIL ROAD MEDICARE |
| 78012465 | Medicaid | KY | |
| 200508940 | Medicaid | IN | |
| 2499167 | Medicaid | OH |
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
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP-03967 | OH | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Internal Medicine Associates, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Cincinnati, OH
- NPI 1588620850
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516320000000",
"number": "1104874254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 636256 CENTRAL CREDENTIALING",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452636256",
"telephone_number": "513-585-5501",
"fax_number": "513-585-5511"
},
{
"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": "513-584-8620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSEN",
"first_name": "DEBRA",
"middle_name": "A",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-04",
"last_updated": "2018-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OH",
"license": "NP-03967",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD MEDICARE",
"identifier": "P00194628",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "78012465",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200508940",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2499167",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cincinnati, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.