Individual provider Active NPI

Clarennce E Johnson, MD

  • Anesthesiology Physician
  • Madison, WI
National Provider Identifier
1205885852
Registry record updated May 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
25837-020 Issued in WI
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

Updated by the provider on May 8, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
4383OtherWIDEAN HEALTH INSURANCE
31560700MedicaidWI

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

LicenseStateTypeSpecialty
25837-020WIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew 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.

Verify at the official NPI Registry.