Active NPI
Robert Dale Johnson, M.D.
- Diagnostic Radiology Physician
- Berlin, VT
National Provider Identifier
1497846067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 042-0005945
- Practice address
- 130 Fisher Rd
Central Vermont Hospital
Berlin, VT 05602-9516 - Phone
- (802) 371-4249
- NPI assigned
- Sep 27, 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 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | 042-0005945 | VT | |
| Diagnostic Radiology Physician | 2085R0202X | 042-0005945 | VT | Primary |
| Diagnostic Ultrasound Physician | 2085U0001X | 042-0005945 | VT | |
| Vascular & Interventional Radiology Physician | 2085R0204X | 042-0005945 | VT | |
| Nuclear Radiology Physician | 2085N0904X | 042-0005945 | VT | |
| Neuroradiology Physician | 2085N0700X | 042-0005945 | VT | |
| Pediatric Radiology Physician | 2085P0229X | 042-0005945 | VT |
Addresses
Primary practice location
130 Fisher Rd
Central Vermont Hospital
Berlin, VT 05602-9516
Mailing address
2759 Crosstown Rd
Berlin, VT 05602-9036
Phone (802) 223-5122
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005065 | Medicaid | VT | |
| 00005065 | Other | VT | BLUE SHIELD |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042-0005945 | VT | MD | Diagnostic Ultrasound Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377993600000",
"number": "1497846067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2759 CROSSTOWN RD",
"city": "BERLIN",
"state": "VT",
"postal_code": "056029036",
"telephone_number": "802-223-5122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 FISHER RD",
"address_2": "CENTRAL VERMONT HOSPITAL",
"city": "BERLIN",
"state": "VT",
"postal_code": "056029516",
"telephone_number": "802-371-4249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "ROBERT",
"middle_name": "DALE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2013-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "2085B0100X",
"taxonomy_group": "",
"desc": "Radiology, Body Imaging",
"state": "VT",
"license": "042-0005945",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "VT",
"license": "042-0005945",
"primary": true
},
{
"code": "2085U0001X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Ultrasound",
"state": "VT",
"license": "042-0005945",
"primary": false
},
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "VT",
"license": "042-0005945",
"primary": false
},
{
"code": "2085N0904X",
"taxonomy_group": "",
"desc": "Radiology, Nuclear Radiology",
"state": "VT",
"license": "042-0005945",
"primary": false
},
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "VT",
"license": "042-0005945",
"primary": false
},
{
"code": "2085P0229X",
"taxonomy_group": "",
"desc": "Radiology, Pediatric Radiology",
"state": "VT",
"license": "042-0005945",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0005065",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "00005065",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berlin, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.