Individual provider Active NPI

Roy Lee Johnson III, M.D.

  • Emergency Medicine Physician
  • Wright Patterson Afb, OH
National Provider Identifier
1417168311
Registry record updated May 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
35.094004 Issued in OH
Practice address
4881 Sugar Maple Dr
Wright Patterson Afb, OH 45433
Phone
(937) 257-0770
NPI assigned
May 24, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 35.094004 OH Primary

Addresses

Primary practice location

4881 Sugar Maple Dr
Wright Patterson Afb, OH 45433

Mailing address

3131 Newmark Dr Ste 220
Miamisburg, OH 45342-5400
Phone (937) 438-8910

Other practice location 1

4881 Sugar Maple Dr
Wright Patterson AFB, OH 45433
Phone (937) 257-0770

Other practice location 2

6147 State Route 122
Middletown, OH 45005-5201
Phone (513) 261-3410

Other practice location 3

405 W Grand Ave
Dayton, OH 45405-7538
Phone (937) 723-3211

Other practice location 4

450 Washington Jackson Rd Ste F
Eaton, OH 45320-8699
Phone (937) 456-8377

Other practice location 5

100 Kettering Way
Franklin, OH 45005-1155
Phone (937) 458-4700

Other practice location 6

8701 Old Troy Pike
Huber Heights, OH 45424-1066
Phone (937) 558-3338

Other practice location 7

1141 N Monroe Dr
Xenia, OH 45385-1619
Phone (937) 352-2500

Other practice location 8

3535 Pentagon Blvd
Beavercreek, OH 45431-1705
Phone (937) 702-4500

Other practice location 9

4000 Miamisburg Centerville Rd
Miamisburg, OH 45342-7615
Phone (937) 384-8791

Other practice location 10

1997 Miamisburg Centerville Rd
Centerville, OH 45459-3811
Phone (937) 401-6228

Other practice location 11

3535 Southern Blvd
Kettering, OH 45429-1221
Phone (937) 395-8166

Other practice location 12

600 W Main St
Troy, OH 45373-2928
Phone (937) 980-7010

Other identifiers 1

IdentifierTypeStateIssuer
2987111MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, WV, MO3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20090916000103 OH Practitioner - Emergency Medicine 7810043890 Reassigns benefits to 3 organizations
I20180927000296 WV Practitioner - Emergency Medicine 7810043890 Reassigns benefits to 1 organization
I20190808001159 MO Practitioner - Emergency Medicine 7810043890 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

405 W Grand Ave
Dayton, OH 45405-7538
Phone (937) 723-3211

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.094004OHMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Specialists Inc Emergency Medicine Current Accepting new patients
Mercy Hospitals East Communities CurrentSince Jul 1, 2019 Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Aug 20, 2018 Accepting new patients
Emergency Professional Services, Inc. Emergency Medicine CurrentSince Nov 26, 2014 Accepting new patients
Ohio Emergency Professionals Inc Emergency Medicine CurrentSince Jul 1, 2018 Accepting new patients
Emergency Medicine Specialists, Inc Emergency Medicine CurrentSince Jun 5, 2018 Accepting new patients
Charleston Area Medical Center Inc CurrentSince Aug 20, 2018 Accepting new patients
Mercy Hospitals East Communities Emergency Medicine CurrentSince Jul 1, 2019 Accepting new patients
Emergency Medicine Specialists Inc Emergency Medicine CurrentSince Jun 5, 2018 Accepting new patients
Samaritan Emergency Corp Emergency Medicine Past Accepting new patients
JTDM Family Practice LLC Past Accepting new patients
Emergency Medicine Specialists Inc Emergency Medicine Past Accepting new patients
Greene Emergency Medical Services Past Accepting new patients

Locations

10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328

901 E 5th St
Washington, MO 63090
Phone (636) 239-8000

3535 Pentagon Blvd
Beavercreek, OH 45431
Phone (937) 702-4000

405 W Grand Ave
Dayton, OH 45405
Phone (937) 226-3200

450 Washington Jackson Rd
#F
Eaton, OH 45320
Phone (937) 456-8376

100 Kettering Way
Franklin, OH 45005
Phone (937) 458-4700

630 Eaton Ave
Hamilton, OH 45013
Phone (513) 867-2000

8701 Troy Pike
Huber Heights, OH 45424
Phone (937) 558-3309

3535 Southern Blvd
Kettering, OH 45429
Phone (937) 298-1221

3131 Newmark Dr
Ste 220
Miamisburg, OH 45342

4000 Miamisburg Centerville Rd
Miamisburg, OH 45342
Phone (937) 384-8791

18697 Bagley Rd
Middleburg Heights, OH 44130
Phone (440) 816-8000

6147 State Route 122
Middletown, OH 45005
Phone (513) 261-3410

2300 N Limestone St
Springfield, OH 45503
Phone (937) 328-7050

600 W Main St
Troy, OH 45373
Phone (937) 395-6665

1997 W Centerville Rd
Washington Township, OH 45459
Phone (937) 401-6000

1141 N Monroe Dr
Xenia, OH 45385
Phone (937) 352-2000

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 5

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": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588636800000",
    "number": "1417168311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 NEWMARK DR STE 220",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453425400",
            "telephone_number": "937-438-8910",
            "fax_number": "937-436-4984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "45433",
            "telephone_number": "937-257-0770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4881 Sugar Maple Dr",
            "address_purpose": "LOCATION",
            "city": "Wright Patterson AFB",
            "state": "OH",
            "postal_code": "45433",
            "country_code": "US",
            "telephone_number": "937-257-0770",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6147 State Route 122",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "OH",
            "postal_code": "450055201",
            "country_code": "US",
            "telephone_number": "513-261-3410",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "405 W Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454057538",
            "country_code": "US",
            "telephone_number": "937-723-3211",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "450 Washington Jackson Rd Ste F",
            "address_purpose": "LOCATION",
            "city": "Eaton",
            "state": "OH",
            "postal_code": "453208699",
            "country_code": "US",
            "telephone_number": "937-456-8377",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Kettering Way",
            "address_purpose": "LOCATION",
            "city": "Franklin",
            "state": "OH",
            "postal_code": "450051155",
            "country_code": "US",
            "telephone_number": "937-458-4700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8701 Old Troy Pike",
            "address_purpose": "LOCATION",
            "city": "Huber Heights",
            "state": "OH",
            "postal_code": "454241066",
            "country_code": "US",
            "telephone_number": "937-558-3338",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1141 N Monroe Dr",
            "address_purpose": "LOCATION",
            "city": "Xenia",
            "state": "OH",
            "postal_code": "453851619",
            "country_code": "US",
            "telephone_number": "937-352-2500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3535 Pentagon Blvd",
            "address_purpose": "LOCATION",
            "city": "Beavercreek",
            "state": "OH",
            "postal_code": "454311705",
            "country_code": "US",
            "telephone_number": "937-702-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4000 Miamisburg Centerville Rd",
            "address_purpose": "LOCATION",
            "city": "Miamisburg",
            "state": "OH",
            "postal_code": "453427615",
            "country_code": "US",
            "telephone_number": "937-384-8791",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1997 Miamisburg Centerville Rd",
            "address_purpose": "LOCATION",
            "city": "Centerville",
            "state": "OH",
            "postal_code": "454593811",
            "country_code": "US",
            "telephone_number": "937-401-6228",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3535 Southern Blvd",
            "address_purpose": "LOCATION",
            "city": "Kettering",
            "state": "OH",
            "postal_code": "454291221",
            "country_code": "US",
            "telephone_number": "937-395-8166",
            "fax_number": "937-395-8347",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 W Main St",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "OH",
            "postal_code": "453732928",
            "country_code": "US",
            "telephone_number": "937-980-7010",
            "fax_number": "937-980-7019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ROY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2020-05-05",
        "certification_date": "2020-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35.094004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2987111",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wright Patterson Afb, OH

Sources for this page

Verify at the official NPI Registry.