NPIMap

Individual provider Active NPI

Michael C Johnson, M.D.

  • Family Medicine Physician
  • Williston, VT
National Provider Identifier
1336158252
Registry record updated Nov 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0420010982 Issued in VT
Practice address
28 Park Ave
Williston, VT 05495-9701
Phone
(802) 878-1008
NPI assigned
Aug 7, 2006
Last updated
Nov 24, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0420010982 VT Primary

Addresses

Primary practice location

28 Park Ave
Williston, VT 05495-9701

Mailing address

28 Park Ave
Williston, VT 05495-9701
Phone (802) 878-1008

Other identifiers 2

IdentifierTypeStateIssuer
1011709MedicaidVT
02667614MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050812000462 VT Practitioner - Family Practice 2769412469 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Evergreen Family Health PartnersGroup PAC ID 1153402888, 20 clinicians

Practice addresses (Care Compare)

28 Park Ave
Williston, VT 05495-9701

426 Industrial Ave
Suite 130
Williston, VT 05495-4449
Phone (802) 878-1008

8 Essex Way
201 Dba Alderbrook Family Health
Essex Junction, VT 05452-3422
Phone (802) 872-7100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0420010982VTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Evergreen Family Health Partners Family Medicine CurrentSince Aug 1, 2005 Accepting new patients
University of Vermont Medical Center Inc Family Medicine PastSince Jul 1, 2020 Accepting new patients
Alder Brook Family Health P.C. Family Medicine PastSince Feb 8, 2015 Accepting new patients

Locations

8 Essex Way
Ste 201
Essex Junction, VT 05452
Phone (802) 872-7100

28 Park Ave
Williston, VT 05495
Phone (802) 878-1008

426 Industrial Ave
Ste 130
Williston, VT 05495
Phone (518) 593-7466

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416787200000",
    "number": "1336158252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 PARK AVE",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054959701",
            "telephone_number": "802-878-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 PARK AVE",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054959701",
            "telephone_number": "802-878-1008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-07",
        "last_updated": "2014-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VT",
            "license": "0420010982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011709",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02667614",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williston, VT

Sources for this page

Verify at the official NPI Registry.