Lyndon G Johansen, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

DP00230 Issued in OR

Practice address

12658 SE Stark St
Portland, OR 97233-1058

Phone

(503) 256-4018

Fax

(503) 256-6298

NPI assigned

Dec 1, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

California School of Podiatric Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Portland Hospital, Portland, OR, CCN 380060

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ljohansen154538@direct.ohsu.edu

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.

• Lyndon G Johansen DPM PC

  • Podiatric Clinic/Center
  • Portland, OR
  • NPI 1093993453

  Podiatrist

  Medicare reassignment NPD Authorized official

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

• Portland Adventist Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1801887658
  Care Compare affiliation

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357084800000",
    "number": "1306820402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12658 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331058",
            "telephone_number": "503-256-4018",
            "fax_number": "503-256-6298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12658 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331058",
            "telephone_number": "503-256-4018",
            "fax_number": "503-256-6298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSEN",
        "first_name": "LYNDON",
        "middle_name": "G",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2013-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OR",
            "license": "DP00230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "045653",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donna L Johannes, ANP, GNP
• Elyse Walker Johansen
• Jennifer Johansen, LMT
• Justine Johansen, RN
• Lisa Ann Johansen, CADC-R
• Mark Ronald Johansen, D.C.
• Priscilla Johansen
• Ronald R Johansen, D.C.
• Winnie Li Johansen
• Katherine Johanson, RPH

• Podiatrist in Portland, OR
• Providers in Portland, OR by specialty
• Podiatrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.