Individual provider Active NPI

Jeffrey E Johnson, MD

  • Orthopaedic Foot and Ankle Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1275551699
Registry record updated Dec 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Foot and Ankle Surgery PhysicianTaxonomy code 207XX0004X
License
111944 Issued in MO
Practice address
4921 Parkview PL
Ste 6a/6B/12a
Saint Louis, MO 63110-1032
Phone
(314) 514-3566
Fax
(314) 514-3689
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X 111944 MO Primary

Addresses

Primary practice location

4921 Parkview PL
Ste 6a/6B/12a
Saint Louis, MO 63110-1032

Mailing address

660 S Euclid Ave
CB 8233
Saint Louis, MO 63110-1010
Phone (314) 514-3500

Other identifiers 2

IdentifierTypeStateIssuer
208699603MedicaidMO
ENROLLEDMedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100127000856 MO Practitioner - Orthopedic Surgery 7315089471 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Dec 9, 1996 Accepting new patients
Shriners Hospitals for Children CurrentSince Jun 5, 2020 Accepting new patients
Shriners Hospitals for Children CurrentSince Jun 5, 2020 Accepting new patients
Washington University CurrentSince Dec 9, 1996 Accepting new patients

Locations

4400 Clayton Ave
Saint Louis, MO 63110
Phone (314) 432-3600

660 S Euclid Ave
#C
Saint Louis, MO 63110

660 S Euclid Ave
#8233
Saint Louis, MO 63110
Phone (314) 747-2555

4921 Parkview Pl
Ste 6A6B12A
Saint Louis, MO 63110
Phone (314) 747-2551

4921 Parkview Pl
Ste 6A6B
Saint Louis, MO 63110
Phone (314) 747-2551

4240 Duncan Ave
Ste 301
Saint Louis, MO 63110

Organizations & group practices 4

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576540800000",
    "number": "1275551699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S EUCLID AVE",
            "address_2": "CB 8233",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101010",
            "telephone_number": "314-514-3500",
            "fax_number": "314-454-8865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4921 PARKVIEW PL",
            "address_2": "STE 6A/6B/12A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101032",
            "telephone_number": "314-514-3566",
            "fax_number": "314-514-3689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JEFFREY",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2019-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "MO",
            "license": "111944",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208699603",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.