Organization Active NPI

Johnson Internal Medicine Inc

  • Internal Medicine Physician
  • Boca Raton, FL
National Provider Identifier
1285663096
Registry record updated May 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS0004672 Issued in FL
Legal business name
JOHNSON INTERNAL MEDICINE INC
Practice address
1601 Clint Moore Rd
#155
Boca Raton, FL 33487-2768
Phone
(561) 338-0700
Fax
(561) 362-9960
NPI assigned
Jul 2, 2006
Last updated
May 26, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2011

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

Authorized official

Name
Dr. C Robert Johnson, DO
Title
President
Phone
(561) 338-0700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS0004672 FL Primary

Addresses

Primary practice location

1601 Clint Moore Rd
#155
Boca Raton, FL 33487-2768

Mailing address

1601 Clint Moore Rd
155
Boca Raton, FL 33487-2768
Phone (561) 338-0700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071023000253 FL Part B Supplier - Clinic/Group Practice 8921194820 Receives reassigned benefits from 3 practitioners
Practice locations: Boca Raton, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0939505Johnson Internal Medicine1601 Clint Moore Rd Ste 155, Boca Raton, FL 33487Certificate of waiverJan 26, 2028

National Provider Directory

National Provider Directory

Locations

1601 Clint Moore Rd
Ste 155
Boca Raton, FL 33487
Phone (561) 338-0700

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HHGACD

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306368000000",
    "number": "1285663096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 CLINT MOORE RD",
            "address_2": "155",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334872768",
            "telephone_number": "561-338-0700",
            "fax_number": "561-362-9960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 CLINT MOORE RD",
            "address_2": "#155",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334872768",
            "telephone_number": "561-338-0700",
            "fax_number": "561-362-9960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON INTERNAL MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2011-05-26",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "C",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-338-0700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS0004672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.