NPIMap

Individual provider Active NPI

Gary Ronald Johnson, M.D.

  • Family Medicine Physician
  • San Andreas, CA
National Provider Identifier
1114013513
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G27755 Issued in CA
Practice address
588 W. St.Charles Street
San Andreas, CA 95249
Phone
(209) 754-1851
Fax
(209) 754-0231
NPI assigned
Oct 4, 2006
Last updated
Nov 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G27755 CA Primary
Internal Medicine Physician 207R00000X G27755 CA
General Practice Physician 208D00000X G27755 CA

Addresses

Primary practice location

588 W. St.Charles Street
San Andreas, CA 95249

Mailing address

PO Box 580
San Andreas, CA 95249
Phone (209) 754-1851

Other identifiers 1

IdentifierTypeStateIssuer
00G277550MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20050411000674 CA Practitioner - General Practice 3971540162 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
University of California, San Diego School of Medicine, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Heritage Health Center IncGroup PAC ID 3577908029, 4 clinicians

Practice addresses (Care Compare)

588 W Saint Charles St
San Andreas, CA 95249-9616
Phone (209) 754-1851

820 E State Hwy 88
Jackson, CA 95642-2134
Phone (209) 223-7040

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
22.86 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
76.2

Merit-based Incentive Payment System (MIPS)

Final score
23.14 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
77.15

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision16
Removal of tissue1-10
Removal of skin lesions45
Removal or shaving of skin growth14
Skin biopsy24

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Gary R Johnson MD, Inc CurrentSince Jun 1, 1995 Accepting new patients
Heritage Health Center Inc Internal Medicine CurrentSince Jan 1, 2024 Accepting new patients

Locations

820 E State Highway 88
Jackson, CA 95642
Phone (209) 223-7040

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730764800000",
    "number": "1114013513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 580",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "95249",
            "telephone_number": "209-754-1851",
            "fax_number": "209-754-0231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "588 W. ST.CHARLES STREET",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "95249",
            "telephone_number": "209-754-1851",
            "fax_number": "209-754-0231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "GARY",
        "middle_name": "RONALD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G27755",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G27755",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "G27755",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G277550",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Andreas, CA

Sources for this page

Verify at the official NPI Registry.