Individual provider Active NPI

Thomas Johnson, D.O.

  • Anesthesiology Physician
  • Ridgewood, NJ
National Provider Identifier
1306103643
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
25MB11982800 Issued in NJ
Practice address
223 N Van Dien Ave
Ridgewood, NJ 07450-2726
Phone
(201) 847-9320
NPI assigned
Apr 11, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 25MB11982800 NJ Primary
Anesthesiology Physician 207L00000X 283799 NY

Addresses

Primary practice location

223 N Van Dien Ave
Ridgewood, NJ 07450-2726

Mailing address

PO Box 630
Franklin Lakes, NJ 07417-0630
Phone (201) 847-9320

Other practice location 1

100 High St
Buffalo, NY 14203-1126
Phone (716) 859-5600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160719002700 NY Practitioner - Anesthesiology 7416240015
I20230920002477 NJ Practitioner - Anesthesiology 7416240015 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
New York College of Osteo Medicine of New York Institute of Technology, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bergen Anesthesia Group, P.C.Group PAC ID 6608861794, 61 clinicians

Practice addresses (Care Compare)

223 N Van Dien Ave
Ridgewood, NJ 07450-2726
Phone (201) 847-9403

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
60.05 of 100Reported as group
Quality
46.59
Improvement activities
40
Cost
64.74

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MB11982800NJMDAnesthesiology Physician
283799NYMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bergen Anesthesia Group, P.C. CurrentSince Sep 15, 2023 Accepting new patients

Locations

223 N Van Dien Ave
Ridgewood, NJ 07450
Phone (201) 447-8417

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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": "1334102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1306103643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 630",
            "city": "FRANKLIN LAKES",
            "state": "NJ",
            "postal_code": "074170630",
            "telephone_number": "201-847-9320",
            "fax_number": "201-847-0059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 N VAN DIEN AVE",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074502726",
            "telephone_number": "201-847-9320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 High St",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142031126",
            "country_code": "US",
            "telephone_number": "716-859-5600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-11",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NJ",
            "license": "25MB11982800",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "283799",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgewood, NJ

Sources for this page

Verify at the official NPI Registry.