NPIMap

Individual provider Active NPI

Alex R Johnson, MD

  • Family Medicine Physician
  • Paola, KS
National Provider Identifier
1467986307
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
04-45104 Issued in KS
Practice address
1318 Kansas Dr
Paola, KS 66071-2107
Phone
(913) 557-5678
Fax
(913) 557-5681
NPI assigned
Apr 18, 2017
Last updated
Oct 6, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 04-45104 KS Primary

Addresses

Primary practice location

1318 Kansas Dr
Paola, KS 66071-2107

Mailing address

1318 Kansas Dr
Paola, KS 66071-2107
Phone (913) 557-5678

Other identifiers 1

IdentifierTypeStateIssuer
30004763240001MedicaidKS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210913001725 KS Practitioner - Family Practice 3375949670 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kansas School of Med (KC/Wich/Sal), 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Miami County Medical Center IncGroup PAC ID 2163311457, 25 clinicians

Practice addresses (Care Compare)

2100 Baptiste Dr
Paola, KS 66071-1314
Phone (913) 294-2327

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
04-45104KSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Miami County Medical Center Inc. Single Specialty CurrentSince Sep 13, 2021 Accepting new patients
Miami County Medical Center Inc. Family Medicine CurrentSince Sep 13, 2021 Accepting new patients
Miami County Medical Center Inc Single Specialty Current Accepting new patients
Olathe Medical Center Inc Past Accepting new patients

Locations

102 Crestview Cir
Louisburg, KS 66053
Phone (913) 837-4299

1318 Kansas Dr
Paola, KS 66071
Phone (913) 557-5678

2100 Baptiste Dr
Paola, KS 66071
Phone (913) 294-2327

Interoperability endpoints

  • Direct secure messaging: ajohnson755640@direct.kuha.org
  • FHIR API: https://fhir-myrecord.cerner.com/r4/9997a5fc-aad4-42a6-b005-45276937bbd0/

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1492473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1467986307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1318 KANSAS DR",
            "city": "PAOLA",
            "state": "KS",
            "postal_code": "660712107",
            "telephone_number": "913-557-5678",
            "fax_number": "913-557-5681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1318 KANSAS DR",
            "city": "PAOLA",
            "state": "KS",
            "postal_code": "660712107",
            "telephone_number": "913-557-5678",
            "fax_number": "913-557-5681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ALEX",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-18",
        "last_updated": "2022-10-06",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-45104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30004763240001",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paola, KS

Sources for this page

Verify at the official NPI Registry.