NPIMap

Individual provider Active NPI

Michael Keith Johnson, MD

  • Family Medicine Physician
  • Huntsville, AL
National Provider Identifier
1174574172
Registry record updated Jan 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20179 Issued in AL
Practice address
2616 Jordan LN NW
Huntsville, AL 35816-1014
Phone
(256) 851-8433
Fax
(256) 851-6080
NPI assigned
May 14, 2006
Last updated
Jan 4, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20179 AL Primary

Addresses

Primary practice location

2616 Jordan LN NW
Huntsville, AL 35816-1014

Mailing address

2616 Jordan LN NW
Huntsville, AL 35816-1014
Phone (256) 851-8433

Other identifiers 1

IdentifierTypeStateIssuer
009943525MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040124000310 AL Practitioner - Family Practice 9335041755 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Creighton University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Huntsville Family Care, P.C.Group PAC ID 7113829631, 2 clinicians

Practice addresses (Care Compare)

2616 Jordan LN NW
Huntsville, AL 35816-1014
Phone (256) 851-8433

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20179ALMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
North Huntsville Family Care, P.C. CurrentSince Nov 1, 2003 Accepting new patients
Lister Healthcare Corporation Family Medicine PastSince Feb 1, 2004 Accepting new patients
LP Huntsville, LLC Past Accepting new patients

Locations

2616 Jordan Ln NW
Huntsville, AL 35816
Phone (256) 851-8433

4831 Sparkman Dr NW
Huntsville, AL 35810
Phone (256) 536-2231

Interoperability endpoints

  • Direct secure messaging: mkjohnson@nhfc.ssdirect.aprima.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Willowbrooke Court Skilled Care Center at Magnolia TraceHuntsville, AL, CCN 015450 Skilled nursing facility Adp of the SNF Feb 16, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672790400000",
    "number": "1174574172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2616 JORDAN LN NW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358161014",
            "telephone_number": "256-851-8433",
            "fax_number": "256-851-6080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2616 JORDAN LN NW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358161014",
            "telephone_number": "256-851-8433",
            "fax_number": "256-851-6080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MICHAEL",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-14",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "20179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009943525",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntsville, AL

Sources for this page

Verify at the official NPI Registry.