Individual provider Active NPI

Ryan Kenji Johnson, M.D.

  • Pediatric Cardiology Physician
  • Tucson, AZ
National Provider Identifier
1114941416
Registry record updated Feb 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
35247 Issued in AZ
Practice address
5983 E Grant Rd
Ste 117
Tucson, AZ 85712-2365
Phone
(602) 933-3166
Fax
(602) 933-4166
NPI assigned
Jul 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35247 AZ
Pediatrics Physician 208000000X 37244 IA
Pediatric Cardiology Physician 2080P0202X 35247 AZ Primary

Addresses

Primary practice location

5983 E Grant Rd
Ste 117
Tucson, AZ 85712-2365

Mailing address

3200 E Camelback Rd
Ste 250
Phoenix, AZ 85018-2311
Phone (602) 933-1813

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061019000668 AZ Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Pediatric Medicine 7911903661 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35247AZMDPediatrics Physician
37244IAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Children's Medical Group CurrentSince Mar 1, 2017 Accepting new patients
Phoenix Children's Hospital Pediatrics Current Accepting new patients
Phoenix Children's Medical Group CurrentSince Mar 1, 2017 Accepting new patients
Obstetrix Medical Group of Phoenix PC Pediatric Cardiology Past Accepting new patients
Obstetrix Medical Group of Phoenix PC Past Accepting new patients

Locations

1780 E Florence Blvd
Ste 102
Casa Grande, AZ 85122
Phone (520) 381-6731

815 E 15th St
Douglas, AZ 85607
Phone (520) 364-5437

5757 W Thunderbird Rd
Ste E353
Glendale, AZ 85306
Phone (480) 315-8412

4995 US Highway 68
Ste 1
Golden Valley, AZ 86413
Phone (928) 681-8500

1260 S Campbell Ave
Bldg 2
Green Valley, AZ 85614
Phone (520) 407-5400

1551 E Tangerine Rd
Ste 141
Oro Valley, AZ 85755
Phone (520) 320-7999

1919 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 933-0777

1920 E Cambridge Ave
Ste 301
Phoenix, AZ 85006
Phone (602) 253-6000

3200 E Camelback Rd
Ste 250
Phoenix, AZ 85018
Phone (602) 933-1814

726 Gail Gardner Way
Ste A
Prescott, AZ 86305
Phone (928) 443-9580

2115 W 16th St
Safford, AZ 85546
Phone (520) 624-7445

10250 N 92nd St
Ste 212
Scottsdale, AZ 85258
Phone (480) 551-5154

155 Calle Portal
Ste 700
Sierra Vista, AZ 85635
Phone (520) 459-0203

5983 E Grant Rd
Ste 117
Tucson, AZ 85712
Phone (520) 320-7999

5301 E Grant Rd
Tucson, AZ 85712
Phone (520) 324-1344

5983 E Grant Rd
Ste 201
Tucson, AZ 85712

Organizations & group practices 5

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": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485907200000",
    "number": "1114941416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 E CAMELBACK RD",
            "address_2": "STE 250",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850182311",
            "telephone_number": "602-933-1813",
            "fax_number": "602-933-1820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5983 E GRANT RD",
            "address_2": "STE 117",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857122365",
            "telephone_number": "602-933-3166",
            "fax_number": "602-933-4166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "RYAN",
        "middle_name": "KENJI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2017-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "35247",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IA",
            "license": "37244",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "AZ",
            "license": "35247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.