Individual provider Active NPI

Andrew James Johnson, MD

  • Otolaryngology Physician
  • Bend, OR
National Provider Identifier
1528621679
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD219072 Issued in OR
Practice address
2450 NE Mary Rose PL Ste 120
Bend, OR 97701-7132
Phone
(541) 312-7056
Fax
(541) 385-4935
NPI assigned
Apr 15, 2019
Last updated
Jul 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD219072 OR Primary

Addresses

Primary practice location

2450 NE Mary Rose PL Ste 120
Bend, OR 97701-7132

Mailing address

2450 NE Mary Rose PL Ste 120
Bend, OR 97701-7132
Phone (541) 382-3100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20240724003560 OR Practitioner - Otolaryngology 7113254202 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2450 NE Mary Rose PL
Suite 120
Bend, OR 97701-7132
Phone (541) 382-3100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.41 of 100Reported as group
Quality
97.23
Improvement activities
40
Cost
78.39

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Central Oregon ENT LLC - Ear Nose Throat and Facial Plastic Surgey Otolaryngology CurrentSince Sep 2, 2024 Accepting new patients

Locations

2450 NE Mary Rose Pl
Ste 120
Bend, OR 97701
Phone (541) 382-3100

1020 SW Indian Ave
Ste 102
Redmond, OR 97756
Phone (541) 504-5363

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1555286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1528621679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 NE MARY ROSE PL STE 120",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017132",
            "telephone_number": "541-382-3100",
            "fax_number": "541-385-4935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 NE MARY ROSE PL STE 120",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017132",
            "telephone_number": "541-312-7056",
            "fax_number": "541-385-4935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ANDREW",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-15",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OR",
            "license": "MD219072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.