John Russell Johansson, DO

Primary specialty

Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X

License

VT 0000304 Issued in VT

Practice address

67 Lincoln St
Essex Junction, VT 05452-3235

Phone

(802) 878-1003

Fax

(802) 878-9961

NPI assigned

Dec 5, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492473600000",
    "number": "1316005960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 LINCOLN ST",
            "city": "ESSEX JUNCTION",
            "state": "VT",
            "postal_code": "054523235",
            "telephone_number": "802-878-9278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 LINCOLN ST",
            "city": "ESSEX JUNCTION",
            "state": "VT",
            "postal_code": "054523235",
            "telephone_number": "802-878-1003",
            "fax_number": "802-878-9961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSSON",
        "first_name": "JOHN",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2017-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "VT",
            "license": "VT 0000304",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "JOVT-9125",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Essex Junction, VT
• Providers in Essex Junction, VT by specialty
• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.