Individual provider Active NPI

Karen Ann Johnson, M.D.

  • Family Medicine Physician
  • Miramar, FL
National Provider Identifier
1114906963
Registry record updated Oct 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30212 Issued in CO
Practice address
3601 SW 160TH Ave
Suite 250
Miramar, FL 33027-6308
Phone
(954) 399-4645
Fax
(855) 855-2792
NPI assigned
Jan 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2016

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 30212 CO Primary

Addresses

Primary practice location

3601 SW 160TH Ave
Suite 250
Miramar, FL 33027-6308

Mailing address

12201 Pecos St
Westminster, CO 80234-3888
Phone (303) 457-4497

Other identifiers 1

IdentifierTypeStateIssuer
01302124MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050117000357 CO Practitioner - Family PracticePractitioner - Peripheral Vascular Disease 2264481233 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Vohra Wound Physicians of the West, P.C. Family Medicine CurrentSince Nov 7, 2016 Accepting new patients
Rocky Mountain Primary Care , PC Family Medicine Past Accepting new patients
Todd Dextradeur MD PC PastSince Sep 1, 2020 Accepting new patients

Locations

3190 S Vaughn Way
Ste 550
Aurora, CO 80014
Phone (303) 955-8096

1960 S Fordham St
Longmont, CO 80503
Phone (719) 473-1105

3601 SW 160th Ave
Ste 250
Miramar, FL 33027
Phone (305) 866-9951

Organizations & group practices 3

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": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476835200000",
    "number": "1114906963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12201 PECOS ST",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "802343888",
            "telephone_number": "303-457-4497",
            "fax_number": "303-254-4369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 SW 160TH AVE",
            "address_2": "SUITE 250",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330276308",
            "telephone_number": "954-399-4645",
            "fax_number": "855-855-2792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KAREN",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-11",
        "last_updated": "2016-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "30212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01302124",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miramar, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.