Michael D Johnson, PA
Individual provider Active NPI Medical Physician Assistant · Newberry, MI
NPI 1417024969 · NPPES record last updated Jun 24, 2009
Key facts
- NPI
- 1417024969
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 5601002886 (MI)
- Practice address
- 502 W Harrie St
Newberry, MI 49868-1209 - Phone
- (906) 293-9233
- Fax
- (906) 293-9285
- NPI assigned
- Nov 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601002886 | MI | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kareem Said MD | Past | Accepting new patients | |
| Munising Memorial Hospital Association | Medical | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 5601002886 | MI | Yes |
Addresses
Primary practice location
502 W Harrie St
Newberry, MI 49868-1209
Mailing address
502 W Harrie St
Newberry, MI 49868-1209
Phone (906) 293-9233
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5411366 | Other | MI | BLUE CROSS BLUE SHIELD |
NPI Registry JSON
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245801600000",
"number": "1417024969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "502 W HARRIE ST",
"city": "NEWBERRY",
"state": "MI",
"postal_code": "498681209",
"telephone_number": "906-293-9233",
"fax_number": "906-293-9285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "502 W HARRIE ST",
"city": "NEWBERRY",
"state": "MI",
"postal_code": "498681209",
"telephone_number": "906-293-9233",
"fax_number": "906-293-9285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MICHAEL",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-29",
"last_updated": "2009-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MI",
"license": "5601002886",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "5411366",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newberry, MI
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All providers in Newberry, MI · Medical Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.