NPIMap

Individual provider Active NPI

Gabriel David Johnson, D.O

  • Family Medicine Physician
  • Viborg, SD
National Provider Identifier
1275938680
Registry record updated Sep 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11074 Issued in SD
Practice address
315 N Washington St
Viborg, SD 57070-2002
Phone
(605) 326-5201
Fax
(605) 326-5196
NPI assigned
Oct 28, 2014
Last updated
Sep 20, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11074 SD Primary

Addresses

Primary practice location

315 N Washington St
Viborg, SD 57070-2002

Mailing address

PO Box 368
Viborg, SD 57070-0368
Phone (605) 326-5161

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181002002173 SD Practitioner - Family Practice 3274842851 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pioneer Memorial Hospital and Health ServicesGroup PAC ID 9234042755, shared by 6 NPIs, 9 clinicians

Practice addresses (Care Compare)

103 W Pioneer
Viborg, SD 57070
Phone (605) 326-5201

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11074SDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pioneer Memorial Hospital & Health Services Current Accepting new patients
Pioneer Memorial Hospital & Health Services CurrentSince Oct 8, 2018 Accepting new patients
Pioneer Memorial Hospital & Health Services Past Accepting new patients
Centerville Care & Rehab Center Inc Past Accepting new patients
Pioneer Memorial Hospital &Health Services Past Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pioneer Memorial Nursing HomeViborg, SD, CCN 435120 Skilled nursing facility Operational/Managerial Control
Other
Adp of the SNF		 Dec 17, 2024
Jul 31, 2018
Dec 17, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537401600000",
    "number": "1275938680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 368",
            "city": "VIBORG",
            "state": "SD",
            "postal_code": "570700368",
            "telephone_number": "605-326-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 N WASHINGTON ST",
            "city": "VIBORG",
            "state": "SD",
            "postal_code": "570702002",
            "telephone_number": "605-326-5201",
            "fax_number": "605-326-5196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "GABRIEL",
        "middle_name": "DAVID",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-10-28",
        "last_updated": "2018-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "11074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Viborg, SD

Sources for this page

Verify at the official NPI Registry.