Individual provider Active NPI

Brenda Camille Johnson, M.D.

  • Internal Medicine Physician
  • Teec Nos Pos, AZ
National Provider Identifier
1295899763
Registry record updated Mar 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD22804 Issued in OR
Practice address
US Hwy 160 & Navajo RT 35
Teec Nos Pos, AZ 86514
Phone
(928) 656-5474
NPI assigned
Dec 20, 2006
Last updated
Mar 27, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD22804 OR Primary

Addresses

Primary practice location

US Hwy 160 & Navajo RT 35
Teec Nos Pos, AZ 86514

Mailing address

US Hwy 160 & Navajo RT 35
HCR 6100 Box 30
Teec Nos Pos, AZ 86514
Phone (928) 656-5474

Other identifiers 1

IdentifierTypeStateIssuer
287966MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20240514001261 TX Practitioner - Internal Medicine 3779616354 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
84.26 of 100Reported as group
Quality
74.27
Improvement activities
40
Cost
78.06

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
22804ORMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Mar 11, 2024 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital Current Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711497600000",
    "number": "1295899763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "US HWY 160 & NAVAJO RT 35",
            "address_2": "HCR 6100 BOX 30",
            "city": "TEEC NOS POS",
            "state": "AZ",
            "postal_code": "86514",
            "telephone_number": "928-656-5474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "US HWY 160 & NAVAJO RT 35",
            "city": "TEEC NOS POS",
            "state": "AZ",
            "postal_code": "86514",
            "telephone_number": "928-656-5474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BRENDA",
        "middle_name": "CAMILLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-20",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD22804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287966",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Teec Nos Pos, AZ

Sources for this page

Verify at the official NPI Registry.