Individual provider Active NPI

Timothy M Johnson, MD

  • MOHS-Micrographic Surgery Physician
  • Ann Arbor, MI
National Provider Identifier
1255428025
Registry record updated Oct 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
4301053410 Issued in MI
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

Updated by the provider on Oct 12, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
1927590MedicaidMI

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
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
92.18 of 100Reported as group
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

LicenseStateTypeSpecialty
4301053410MIMDMOHS-Micrographic Surgery Physician

Interoperability endpoints

  • Direct secure messaging: 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

Verify at the official NPI Registry.