Individual provider Active NPI

Pierre M Johnson, M.D.

  • Internal Medicine Physician
  • Fairbanks, AK
National Provider Identifier
1447353743
Registry record updated Sep 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
6017 Issued in AK
Practice address
2555 Phillips Field Rd
Fairbanks, AK 99709-3933
Phone
(907) 328-2920
Fax
(907) 456-2914
NPI assigned
Sep 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5263105-1205 UT
Internal Medicine Physician 207R00000X 6017 AK Primary

Addresses

Primary practice location

2555 Phillips Field Rd
Fairbanks, AK 99709-3933

Mailing address

2555 Phillips Field Rd
Fairbanks, AK 99709-3933
Phone (907) 328-2920

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
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 1

Enrollment IDStateProvider typePAC IDDetails
I20080129000769 AK Practitioner - Internal Medicine 9830271808

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6017AKMDLicensed Practical Nurse
5263105-1205UTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pierre M Johnson, MD PC Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442448000000",
    "number": "1447353743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2555 PHILLIPS FIELD RD",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997093933",
            "telephone_number": "907-328-2920",
            "fax_number": "907-456-2914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 PHILLIPS FIELD RD",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997093933",
            "telephone_number": "907-328-2920",
            "fax_number": "907-456-2914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "PIERRE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2015-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "5263105-1205",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AK",
            "license": "6017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

Verify at the official NPI Registry.