Individual provider Active NPI

John Michael Jansen

  • Pediatrics Physician
  • Lexington, KY
National Provider Identifier
1154855054
Registry record updated Jul 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
54025 Issued in KY
Practice address
3320 Tates Creek Rd Ste 302
Lexington, KY 40502-3400
Phone
(859) 269-4604
NPI assigned
Apr 18, 2017
Last updated
Jul 7, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 54025 KY Primary

Addresses

Primary practice location

3320 Tates Creek Rd Ste 302
Lexington, KY 40502-3400

Mailing address

3320 Tates Creek Rd Ste 302
Lexington, KY 40502-3400
Phone (859) 269-4604

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20170608001734 TN Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 8921376302

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
54025KYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Warner and Jansen Pediatrics, PLLC Pediatrics PastSince Jul 12, 2020 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1492473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594080000000",
    "number": "1154855054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3320 TATES CREEK RD STE 302",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405023400",
            "telephone_number": "859-269-4604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3320 TATES CREEK RD STE 302",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405023400",
            "telephone_number": "859-269-4604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANSEN",
        "first_name": "JOHN",
        "middle_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-18",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "54025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.