Individual provider Active NPI

Michael L Johnson, MD

  • Dermatology Physician
  • Northport, AL
National Provider Identifier
1114968443
Registry record updated Oct 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
00007004 Issued in AL
Practice address
4410 Watermelon Rd
Northport, AL 35473-5204
Phone
(205) 345-1520
Fax
(205) 345-1761
NPI assigned
Jun 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 00007004 AL Primary

Addresses

Primary practice location

4410 Watermelon Rd
Northport, AL 35473-5204

Mailing address

4410 Watermelon Rd
Northport, AL 35473-5204
Phone (205) 345-1520

Other identifiers 2

IdentifierTypeStateIssuer
051043258OtherALBCBS AL
000043258MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20080916000243 AL Practitioner - Dermatology 9335138957 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.04 of 100Reported as group
Quality
100
Promoting interoperability
100
Improvement activities
40
Cost
76.79

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7004ALMDPharmacist
00007004ALMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alabama Dermatology Associates, PC CurrentSince Oct 1, 1985 Accepting new patients

Locations

4410 Watermelon Rd
Northport, AL 35473
Phone (205) 345-1520

3519 Watermelon Rd
Northport, AL 35473
Phone (205) 345-1520

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.

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288310400000",
    "number": "1114968443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4410 WATERMELON RD",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354735204",
            "telephone_number": "205-345-1520",
            "fax_number": "205-345-1761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 WATERMELON RD",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354735204",
            "telephone_number": "205-345-1520",
            "fax_number": "205-345-1761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MICHAEL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2010-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AL",
            "license": "00007004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS AL",
            "identifier": "051043258",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000043258",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northport, AL

Sources for this page

Verify at the official NPI Registry.