Active NPI
Richard Kent Johansen, MD
- Obstetrics & Gynecology Physician
- Flagstaff, AZ
National Provider Identifier
1144213596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 20135
- Practice address
- 1100 N San Francisco St
Ste B
Flagstaff, AZ 86001-3260 - Phone
- (928) 779-7851
- Fax
- (928) 774-0508
- NPI assigned
- Aug 31, 2005
- 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 |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 20135 | AZ | Primary |
Addresses
Primary practice location
1100 N San Francisco St
Ste B
Flagstaff, AZ 86001-3260
Mailing address
1100 N San Francisco St
Ste B
Flagstaff, AZ 86001-3260
Phone (928) 779-7851
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 053405 | 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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20135 | AZ | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344211200000",
"number": "1144213596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 N SAN FRANCISCO ST",
"address_2": "STE B",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860013260",
"telephone_number": "928-779-7851",
"fax_number": "928-774-0508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 N SAN FRANCISCO ST",
"address_2": "STE B",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860013260",
"telephone_number": "928-779-7851",
"fax_number": "928-774-0508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHANSEN",
"first_name": "RICHARD",
"middle_name": "KENT",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-31",
"last_updated": "2012-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "AZ",
"license": "20135",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "053405",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.