Active NPI
Zach Johnson, D.O.
- Pediatrics Physician
- Hannibal, MO
National Provider Identifier
1316232325
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 2015029479
- Practice address
- 100 Medical Dr
Hannibal, MO 63401-6877 - Phone
- (573) 221-5250
- Fax
- (573) 231-3824
- NPI assigned
- Jun 17, 2011
- Last updated
- Nov 13, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 2015029479 | MO | Primary |
Addresses
Primary practice location
100 Medical Dr
Hannibal, MO 63401-6877
Mailing address
100 Medical Dr
Hannibal, MO 63401-6877
Phone (573) 221-5250
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731456000000",
"number": "1316232325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 MEDICAL DR",
"city": "HANNIBAL",
"state": "MO",
"postal_code": "634016877",
"telephone_number": "573-221-5250",
"fax_number": "573-231-3824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MEDICAL DR",
"city": "HANNIBAL",
"state": "MO",
"postal_code": "634016877",
"telephone_number": "573-221-5250",
"fax_number": "573-231-3824"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "ZACH",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-17",
"last_updated": "2024-11-13",
"certification_date": "2024-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "2015029479",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hannibal, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.