John Bernard Johnson III, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

12007783A Issued in IN

Practice address

6215 Central Ave
Portage, IN 46368-3725

Phone

(219) 763-1502

Fax

(219) 762-3100

NPI assigned

Feb 11, 2007

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

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Porter-Starke Services Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Valparaiso, IN
  • NPI 1689627598
  Medicare reassignment NPD
• Porter-Starke Services Inc.

  • Federally Qualified Health Center (FQHC)
  • Valparaiso, IN
  • NPI 1659196236
  NPD
• Porter-Starke Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hebron, IN
  • NPI 1447815758
  NPD

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

{
    "created_epoch": "1171152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366583387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6215 CENTRAL AVE",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463683725",
            "telephone_number": "219-763-1502",
            "fax_number": "219-762-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6215 CENTRAL AVE",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463683725",
            "telephone_number": "219-763-1502",
            "fax_number": "219-762-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JOHN",
        "middle_name": "BERNARD",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12007783A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENCE",
            "identifier": "12007783A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Scott Jardenil, D.D.S.
• Jeffrey R Robertson Inc
• Katherine J Jeffries
• Jasmine Jeronimo
• Johnson Memorial Hospital
• Julie A Johnson, PTA
• Melissa Johnson
• Stephanie D Joly, D.D.S
• Dana Dawnielle Jones, MD
• Journey 2 Hope LLC

• Dentist in Portage, IN
• Providers in Portage, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.