Active NPI
Byron Johnson, MD
- Pediatrics Physician
- Roseville, MN
National Provider Identifier
1215368071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 18769
- Practice address
- 1944 Shryer Ave W
Roseville, MN 55113-5415 - Phone
- (651) 633-9080
- NPI assigned
- Dec 4, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 18769 | MN | Primary |
Addresses
Primary practice location
1944 Shryer Ave W
Roseville, MN 55113-5415
Mailing address
856 Manomin Ave
Saint Paul, MN 55107-3512
Phone (651) 227-4848
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 900282100 | Medicaid | MN |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18769 | MN | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386115200000",
"number": "1215368071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "856 MANOMIN AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551073512",
"telephone_number": "651-227-4848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1944 SHRYER AVE W",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551135415",
"telephone_number": "651-633-9080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "BYRON",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-12-04",
"last_updated": "2013-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "18769",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "900282100",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.