NPIMap

Organization Active NPI

Brian a Johnson MD PC

Doing business as Brian a Johnson MD

  • Non-Pharmacy Dispensing Site
  • Winamac, IN
National Provider Identifier
1467535799
Registry record updated Jun 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
5003424A Issued in IN
Legal business name
BRIAN A JOHNSON MD PC
Doing business as
Brian a Johnson MD
Practice address
613 Terrace Dr
Winamac, IN 46996-1111
Phone
(574) 946-6644
NPI assigned
Oct 23, 2006
Last updated
Jun 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2008

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

Authorized official

Name
Direndia Shackelford
Title
Managed Care Specialist
Phone
(800) 654-0889

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 5003424A IN Primary

Addresses

Primary practice location

613 Terrace Dr
Winamac, IN 46996-1111

Mailing address

613 Terrace Dr
Winamac, IN 46996-1111
Phone (574) 946-6644

Other identifiers 2

IdentifierTypeStateIssuer
100210710MedicaidIN
1535561OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • BRIAN A JOHNSON MD Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213920000000",
    "number": "1467535799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 TERRACE DR",
            "city": "WINAMAC",
            "state": "IN",
            "postal_code": "469961111",
            "telephone_number": "574-946-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 TERRACE DR",
            "city": "WINAMAC",
            "state": "IN",
            "postal_code": "469961111",
            "telephone_number": "574-946-6644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN A JOHNSON MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2008-06-20",
        "status": "A",
        "authorized_official_last_name": "SHACKELFORD",
        "authorized_official_first_name": "DIRENDIA",
        "authorized_official_title_or_position": "MANAGED CARE SPECIALIST",
        "authorized_official_telephone_number": "800-654-0889"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "IN",
            "license": "5003424A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100210710",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1535561",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRIAN A JOHNSON MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winamac, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.