Theodore Eugene Johnsrude, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

MD00019724 Issued in WA

Practice address

9398 Ridgetop Blvd NW
Silverdale, WA 98383-8505

Phone

(360) 782-3200

Fax

(360) 782-3245

NPI assigned

May 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1265484299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2512 WHEATON WAY",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983103399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9398 RIDGETOP BLVD NW",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983838505",
            "telephone_number": "360-782-3200",
            "fax_number": "360-782-3245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSRUDE",
        "first_name": "THEODORE",
        "middle_name": "EUGENE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WA",
            "license": "MD00019724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "75433",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8316200",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5358025",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "JO4187",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heidi Lee Johnson, LMP
• Jameson Johnson
• Jerrold Stuart Johnson, DDS, MS
• Nailah Johnson
• Nicholas Paul Johnson, DNP, ARNP
• Mickaila J Johnston, M.D.
• Dani Michele Jones, LMHC
• Jackielyn T Jones, LMHCA
• Kari M Jones, O.D.
• Kieran Jones, L.AC.

• Urology Physician in Silverdale, WA
• Providers in Silverdale, WA by specialty
• Urology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.