Active NPI
Clark Peter Johnson, DPM
- Podiatrist
- Battle Creek, MI
National Provider Identifier
1548220700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 5901000962
- Practice address
- 213 North Ave
Battle Creek, MI 49017-3430 - Phone
- (269) 968-6000
- Fax
- (269) 968-3015
- NPI assigned
- Mar 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 5901000962 | MI | Primary |
| Primary Podiatric Medicine Podiatrist | 213EP1101X | 5901000962 | MI | |
| Foot Surgery Podiatrist | 213ES0131X | 5901000962 | MI |
Addresses
Primary practice location
213 North Ave
Battle Creek, MI 49017-3430
Mailing address
213 North Ave
Battle Creek, MI 49017-3430
Phone (269) 968-6000
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4851350000 | Other | MI | BCBSM |
| 0980190001 | Other | MI | ADMINASTAR DMERC |
| 5212079 | Other | MI | AETNA |
| 1342674 | Medicaid | MI | |
| 2730002 | Other | MI | PHP IBA |
| 121508 | Other | MI | PREFERRED CHOICES |
| P53895 | Other | MI | BLUE CARE NETWORK |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187568000000",
"number": "1548220700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "213 NORTH AVE",
"city": "BATTLE CREEK",
"state": "MI",
"postal_code": "490173430",
"telephone_number": "269-968-6000",
"fax_number": "269-968-3015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "213 NORTH AVE",
"city": "BATTLE CREEK",
"state": "MI",
"postal_code": "490173430",
"telephone_number": "269-968-6000",
"fax_number": "269-968-3015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "CLARK",
"middle_name": "PETER",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-23",
"last_updated": "2007-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "MI",
"license": "5901000962",
"primary": true
},
{
"code": "213EP1101X",
"taxonomy_group": "",
"desc": "Podiatrist, Primary Podiatric Medicine",
"state": "MI",
"license": "5901000962",
"primary": false
},
{
"code": "213ES0131X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot Surgery",
"state": "MI",
"license": "5901000962",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "4851350000",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ADMINASTAR DMERC",
"identifier": "0980190001",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5212079",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1342674",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHP IBA",
"identifier": "2730002",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CHOICES",
"identifier": "121508",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE NETWORK",
"identifier": "P53895",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Battle Creek, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.