NPIMap

Individual provider Active NPI

David M Johnson, MD

  • Family Medicine Physician
  • Jacksonville Beach, FL
National Provider Identifier
1386616795
Registry record updated Nov 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME76227 Issued in FL
Practice address
900 Beach Blvd
Jacksonville Beach, FL 32250-4368
Phone
(904) 249-0335
Fax
(904) 249-0347
NPI assigned
Feb 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2010

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 ME76227 FL Primary

Addresses

Primary practice location

900 Beach Blvd
Jacksonville Beach, FL 32250-4368

Mailing address

900 Beach Blvd
Jacksonville Beach, FL 32250-4368
Phone (904) 249-0335

Other identifiers 1

IdentifierTypeStateIssuer
2543737-00MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20100419000695 FL Practitioner - Family Practice 2769519008 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical University of South Carolina College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Florida Medical Clinic IncGroup PAC ID 7315970688, 2 clinicians

Practice addresses (Care Compare)

1361 13TH Ave S
Suite 150
Jacksonville Beach, FL 32250-3235
Phone (904) 242-7177

Hospital & facility affiliations

  • Bravery Home Healthcare Home health agency, St Augustine, FL, CCN 687344
  • Brooks Rehabilitation Home Health Home health agency, Jacksonville, FL, CCN 103174
  • Baptist Home Health Care by Bayada Home health agency, Jacksonville, FL, CCN 107482
  • Pinnacle Home Care Home health agency, Ormond Beach, FL, CCN 108499
  • Concierge Home Care Home health agency, Jacksonville, FL, CCN 687131
  • Community Hospice of Northeast Florida Inc Hospice, Jacksonville, FL, CCN 101500
  • Baptist Medical Center Beaches Hospital, Jacksonville Beach, FL, CCN 100117
  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
  • HCA Florida Memorial Hospital Hospital, Jacksonville, FL, CCN 100179
  • Brooks Rehabilitation Hospital University Campus Inpatient rehabilitation facility, Jacksonville, FL, CCN 103039

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME76227FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Florida Medical Clinic Inc CurrentSince Mar 12, 2013 Accepting new patients
Baptist Primary Care Inc Family Medicine Past Accepting new patients
Baptist Primary Care Inc Family Medicine Past Accepting new patients

Locations

1361 13th Ave S
Ste 150
Jax Bch, FL 32250
Phone (904) 242-7177

Interoperability endpoints

  • Direct secure messaging: david.johnson.1@32807.direct.athenahealth.com

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 and National Provider Directory roles.

Hospital & facility affiliations 11

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": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289952000000",
    "number": "1386616795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 BEACH BLVD",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322504368",
            "telephone_number": "904-249-0335",
            "fax_number": "904-249-0347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 BEACH BLVD",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322504368",
            "telephone_number": "904-249-0335",
            "fax_number": "904-249-0347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DAVID",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-02",
        "last_updated": "2010-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME76227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2543737-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville Beach, FL

Sources for this page

Verify at the official NPI Registry.