Active NPI
Timothy M Johnson, MD
- MOHS-Micrographic Surgery Physician
- Ann Arbor, MI
National Provider Identifier
1255428025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- MOHS-Micrographic Surgery Physician
- License
- 4301053410
- Practice address
- 1979 Huron Pkwy
Ann Arbor, MI 48104-4141 - Phone
- (734) 344-4567
- Fax
- (734) 669-1104
- NPI assigned
- Oct 5, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 4301053410 | MI | |
| Procedural Dermatology Physician | 207NS0135X | 4301053410 | MI | |
| MOHS-Micrographic Surgery Physician | 207ND0101X | 4301053410 | MI | Primary |
Addresses
Primary practice location
1979 Huron Pkwy
Ann Arbor, MI 48104-4141
Mailing address
1979 Huron Pkwy
Ann Arbor, MI 48104-4141
Phone (734) 344-4567
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1927590 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Care Compare profile
Medicare Care CompareMerit-based Incentive Payment System (MIPS)
- Final score
- 92.18 of 100
- Quality
- 89.06
- Promoting interoperability
- 94
- Improvement activities
- 40
- Cost
- 89.89
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301053410 | MI | MD | MOHS-Micrographic Surgery Physician |
Interoperability endpoints
- tim@gangerderm.emadirect.md
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602460800000",
"number": "1255428025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1979 HURON PKWY",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481044141",
"telephone_number": "734-344-4567",
"fax_number": "734-669-1104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1979 HURON PKWY",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481044141",
"telephone_number": "734-344-4567",
"fax_number": "734-669-1104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "TIMOTHY",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-05",
"last_updated": "2020-10-12",
"certification_date": "2020-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MI",
"license": "4301053410",
"primary": false
},
{
"code": "207NS0135X",
"taxonomy_group": "",
"desc": "Dermatology, Procedural Dermatology",
"state": "MI",
"license": "4301053410",
"primary": false
},
{
"code": "207ND0101X",
"taxonomy_group": "",
"desc": "Dermatology, MOHS-Micrographic Surgery",
"state": "MI",
"license": "4301053410",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1927590",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.