Active NPI
Clarennce E Johnson, MD
- Anesthesiology Physician
- Madison, WI
National Provider Identifier
1205885852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 25837-020
- Practice address
- 700 S Park St
St Marys Hospital/Dean Medical Center
Madison, WI 53715-1849 - Phone
- (608) 258-6975
- Fax
- (608) 258-5222
- NPI assigned
- May 10, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 25837-020 | WI | Primary |
Addresses
Primary practice location
700 S Park St
St Marys Hospital/Dean Medical Center
Madison, WI 53715-1849
Mailing address
700 S Park St
St Marys Hospital/Dean Medical Center
Madison, WI 53715-1849
Phone (608) 258-6975
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4383 | Other | WI | DEAN HEALTH INSURANCE |
| 31560700 | Medicaid | WI |
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 |
|---|---|---|---|
| 25837-020 | WI | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dean Health Systems, Inc | Anesthesiology | Current | Accepting new patients |
Locations
1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497
700 S Park St
Madison, WI 53715
Phone (608) 260-2900
515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210204800000",
"number": "1205885852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 S PARK ST",
"address_2": "ST MARYS HOSPITAL/DEAN MEDICAL CENTER",
"city": "MADISON",
"state": "WI",
"postal_code": "537151849",
"telephone_number": "608-258-6975",
"fax_number": "608-258-5222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 S PARK ST",
"address_2": "ST MARYS HOSPITAL/DEAN MEDICAL CENTER",
"city": "MADISON",
"state": "WI",
"postal_code": "537151849",
"telephone_number": "608-258-6975",
"fax_number": "608-258-5222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "CLARENNCE",
"middle_name": "E",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-10",
"last_updated": "2008-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "WI",
"license": "25837-020",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEAN HEALTH INSURANCE",
"identifier": "4383",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31560700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.