Active NPI
Michael A Johnson, MD
- Pediatrics Physician
- West Allis, WI
National Provider Identifier
1366403743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 38024
- Practice address
- 801 S 70TH St
West Allis, WI 53214-3147 - Phone
- (414) 773-6600
- Fax
- (414) 773-6656
- NPI assigned
- Mar 28, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 38024 | WI | Primary |
Addresses
Primary practice location
801 S 70TH St
West Allis, WI 53214-3147
Mailing address
4425 N Port Washington Rd
Attn: Clinic Credentialing
Glendale, WI 53212-1082
Phone (414) 773-6600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32485000 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Columbia St. Mary'S Hospital Milwaukee, Inc | Current | Accepting new patients | |
| Columbia St. Mary'S Hospital Milwaukee, Inc | Current | Accepting new patients | |
| Columbia St. Mary'S Hospital Milwaukee Inc | Current | Accepting new patients | |
| Columbia St. Mary'S Hospital Milwaukee, Inc | Past | Accepting new patients |
Locations
4425 N Port Washington Rd
Glendale, WI 53212
Phone (414) 326-2218
801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600
Organizations & group practices 4
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.
-
- Multi-Specialty Clinic/Center
- Milwaukee, WI
- NPI 1023064482
-
- Psychiatric Hospital Unit
- Mequon, WI
- NPI 1417600909
-
- Psychiatric Hospital Unit
- Milwaukee, WI
- NPI 1811926132
-
- Multi-Specialty Clinic/Center
- Mequon, WI
- NPI 1710928221
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339977600000",
"number": "1366403743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4425 N PORT WASHINGTON RD",
"address_2": "ATTN: CLINIC CREDENTIALING",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532121082",
"telephone_number": "414-773-6600",
"fax_number": "414-773-6656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 S 70TH ST",
"city": "WEST ALLIS",
"state": "WI",
"postal_code": "532143147",
"telephone_number": "414-773-6600",
"fax_number": "414-773-6656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MICHAEL",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-28",
"last_updated": "2012-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WI",
"license": "38024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32485000",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in West Allis, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2012; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.