Active NPI
Paul G Johnson, MD
- Family Medicine Physician
- Garden Grove, CA
National Provider Identifier
1497790661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- G18771
- Practice address
- 12462 Brookhurst St
#A&B
Garden Grove, CA 92840-4759 - Phone
- (714) 636-9850
- Fax
- (714) 636-1248
- NPI assigned
- Jun 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G18771 | CA | Primary |
Addresses
Primary practice location
12462 Brookhurst St
#A&B
Garden Grove, CA 92840-4759
Mailing address
PO Box 2989
Seal Beach, CA 90740-1989
Phone (714) 379-3221
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G187710 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G18771 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pathway Medical Group, Inc | Family Medicine | Past | Accepting new patients |
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Garden Grove, CA
- NPI 1184670762
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206403200000",
"number": "1497790661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2989",
"city": "SEAL BEACH",
"state": "CA",
"postal_code": "907401989",
"telephone_number": "714-379-3221",
"fax_number": "714-379-3211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12462 BROOKHURST ST",
"address_2": "#A&B",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928404759",
"telephone_number": "714-636-9850",
"fax_number": "714-636-1248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "PAUL",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-19",
"last_updated": "2008-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "G18771",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G187710",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.