NPIMap

Organization Active NPI

Johnson Dermatology Clinic PLLC

Doing business as Johnson Dermatology

  • Dermatology Physician
  • Fort Smith, AR
National Provider Identifier
1437110962
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MC-2480 Issued in AR
Legal business name
JOHNSON DERMATOLOGY CLINIC PLLC
Doing business as
Johnson Dermatology
Practice address
5921 Riley Park Dr
Fort Smith, AR 72916-6103
Phone
(479) 649-3376
Fax
(479) 646-0133
NPI assigned
Apr 2, 2006
Last updated
Aug 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

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

Authorized official

Name
Dr. Sandra Marchese Johnson, MDNPI 1447256102
Title
General Manager
Phone
(479) 649-3376

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU
Dermatology Physician 207N00000X MC-2480 AR Primary
MOHS-Micrographic Surgery Physician 207ND0101X NU
Dermatopathology Physician 207ND0900X NU
Clinical & Laboratory Dermatological Immunology Physician 207NI0002X NU
Pediatric Dermatology Physician 207NP0225X NU
Procedural Dermatology Physician 207NS0135X NU

Addresses

Primary practice location

5921 Riley Park Dr
Fort Smith, AR 72916-6103

Mailing address

5921 Riley Park Dr
Fort Smith, AR 72916-6103
Phone (479) 649-3376

Other practice location 1

195 highway 64 east
Alma, AR 72921
Phone (479) 649-3376

Other names 1

  • Johnson Dermatology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060908000043 AR Part B Supplier - Clinic/Group Practice 4789688615 Receives reassigned benefits from 12 practitioners
Practice locations: Alma, AR; Fort Smith, AR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D1052897Johnson Dermatology Clinic, PLLC5921 Riley Park Drive, Fort Smith, AR 72916ComplianceJun 18, 2027

National Provider Directory

National Provider Directory

Locations

5921 Riley Park Dr
Fort Smith, AR 72916
Phone (479) 649-3376

9207 Highway 71 S
Ste 9
Fort Smith, AR 72916
Phone (479) 649-3376

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1143936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693440000000",
    "number": "1437110962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5921 RILEY PARK DR",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729166103",
            "telephone_number": "479-649-3376",
            "fax_number": "479-646-0133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5921 RILEY PARK DR",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729166103",
            "telephone_number": "479-649-3376",
            "fax_number": "479-646-0133"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "195 highway 64 east",
            "address_purpose": "LOCATION",
            "city": "Alma",
            "state": "AR",
            "postal_code": "72921",
            "country_code": "US",
            "telephone_number": "479-649-3376",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JOHNSON DERMATOLOGY CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-02",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "MARCHESE",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "479-649-3376",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AR",
            "license": "MC-2480",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Johnson Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Johnson Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Smith, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.