Individual provider Active NPI

Jenifer M Johnson, MD

  • Family Medicine Physician
  • Rye, NY
National Provider Identifier
1174502918
Registry record updated Jul 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
236084 Issued in NY
Practice address
1 Theall Rd
Rye, NY 10580-1404
Phone
(914) 848-8700
Fax
(914) 848-8701
NPI assigned
Jan 11, 2006
Last updated
Jul 29, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 236084 NY Primary
Family Medicine Physician 207Q00000X 053095 CT

Addresses

Primary practice location

1 Theall Rd
Rye, NY 10580-1404

Mailing address

1 Theall Rd
Rye, NY 10580-1404
Phone (914) 848-8700

Other identifiers 2

IdentifierTypeStateIssuer
02703148MedicaidNY
236084-01 CFPOtherNYWORKERS COMPENSATION

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CT2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20051230000215 NY Practitioner - Family Practice 7214959527 Reassigns benefits to 1 organization
I20140701001281 CT Practitioner - Family Practice 7214959527 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Westchester Medical Group PC CurrentSince Oct 1, 2005 Accepting new patients
Westchester Medical Group, P.C. CurrentSince Oct 1, 2005 Accepting new patients

Locations

5 Perryridge Rd
Greenwich, CT 06830
Phone (203) 661-5330

1 Theall Rd
Rye, NY 10580
Phone (914) 848-8700

210 Westchester Ave
White Plains, NY 10604
Phone (914) 681-3100

Interoperability endpoints

  • Direct secure messaging: jjohnson@hiemail.healtheconnections.org

Organizations & group practices 2

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": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406592000000",
    "number": "1174502918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 THEALL RD",
            "city": "RYE",
            "state": "NY",
            "postal_code": "105801404",
            "telephone_number": "914-848-8700",
            "fax_number": "914-848-8701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 THEALL RD",
            "city": "RYE",
            "state": "NY",
            "postal_code": "105801404",
            "telephone_number": "914-848-8700",
            "fax_number": "914-848-8701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JENIFER",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-11",
        "last_updated": "2014-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "236084",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "053095",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02703148",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION",
            "identifier": "236084-01 CFP",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rye, NY

Sources for this page

Verify at the official NPI Registry.