NPIMap

Individual provider Active NPI

Gil Johnson, M.D.

  • Adult Medicine Physician
  • Conway, AR
National Provider Identifier
1356563241
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
MC1518 Issued in AR
Practice address
2511 A College Ave
Conway, AR 72034-6135
Phone
(501) 327-6041
Fax
(501) 327-6043
NPI assigned
May 2, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X MC1518 AR Primary

Addresses

Primary practice location

2511 A College Ave
Conway, AR 72034-6135

Mailing address

2511 A College Ave
Conway, AR 72034-6135
Phone (501) 327-6041

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20060508000983 AR Practitioner - Family PracticePractitioner - General Practice 9133139421 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2511 College Ave
Suite a
Conway, AR 72034-6273
Phone (501) 924-6041

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MC1518ARMDAdult Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
College Park Family Clinic PA Adult Medicine CurrentSince Apr 30, 1994 Accepting new patients

Locations

2511 College Ave
Ste A
Conway, AR 72034
Phone (501) 327-6041

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356563241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2511 A COLLEGE AVE",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720346135",
            "telephone_number": "501-327-6041",
            "fax_number": "501-327-6043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511 A COLLEGE AVE",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720346135",
            "telephone_number": "501-327-6041",
            "fax_number": "501-327-6043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "GIL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "AR",
            "license": "MC1518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.