Active NPI
Rodney Jamar Johnson, RN
- Assisted Living Facility
- Surprise, AZ
National Provider Identifier
1134617046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- AL10660H
- Practice address
- 14384 W Maui LN
Surprise, AZ 85379-8529 - Phone
- (623) 556-9009
- NPI assigned
- Apr 25, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | AL10660H | AZ | Primary |
Addresses
Primary practice location
14384 W Maui LN
Surprise, AZ 85379-8529
Mailing address
14384 W Maui LN
Surprise, AZ 85379-8529
Phone (623) 556-9009
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 360398 | Medicaid | AZ |
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)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL10660H | AZ | MD | Assisted Living Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524614400000",
"number": "1134617046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14384 W MAUI LN",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853798529",
"telephone_number": "623-556-9009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14384 W MAUI LN",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853798529",
"telephone_number": "623-556-9009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "RODNEY",
"middle_name": "JAMAR",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-04-25",
"last_updated": "2018-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "AZ",
"license": "AL10660H",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "360398",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Surprise, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 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.