Active NPI
Antonio De'Shawn Johnson
- Case Manager/Care Coordinator
- Edmond, OK
National Provider Identifier
1285198721
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- 0000
- Practice address
- 400 S Broadway Ste 6
Edmond, OK 73034-3848 - Phone
- (405) 763-8063
- NPI assigned
- Jan 29, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 0000 | OK | Primary |
Addresses
Primary practice location
400 S Broadway Ste 6
Edmond, OK 73034-3848
Mailing address
6213 Sudbury Dr
Oklahoma City, OK 73162-1724
Phone (405) 503-9315
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000 | OK | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548720000000",
"number": "1285198721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6213 SUDBURY DR",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731621724",
"telephone_number": "405-503-9315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 S BROADWAY STE 6",
"city": "EDMOND",
"state": "OK",
"postal_code": "730343848",
"telephone_number": "405-763-8063"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "ANTONIO",
"middle_name": "DE'SHAWN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-01-29",
"last_updated": "2019-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "OK",
"license": "0000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.