Individual provider Active NPI

Walter Stuart Johnston, M.D.

  • Surgery Physician
  • Richardson, TX
National Provider Identifier
1558312504
Registry record updated Mar 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
J4238 Issued in TX
Practice address
3600 Shire Blvd Ste 104
Richardson, TX 75082-2236
Phone
(972) 487-6400
Fax
(972) 487-1686
NPI assigned
May 15, 2006
Last updated
Mar 7, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X J4238 TX Primary

Addresses

Primary practice location

3600 Shire Blvd Ste 104
Richardson, TX 75082-2236

Mailing address

3600 Shire Blvd Ste 104
Richardson, TX 75082-2236
Phone (972) 487-6400

Other identifiers 2

IdentifierTypeStateIssuer
88720GOtherTXBLUE CROSS BLUE SHIELD
125237104MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20110824000357 TX Practitioner - General Surgery 5597935809 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Texas Southwestern Medical School at Dallas, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Dallas Surgical Specialists, PAGroup PAC ID 7315998929, 5 clinicians

Practice addresses (Care Compare)

3600 Shire Blvd
Suite 104
Richardson, TX 75082-2236
Phone (972) 487-6400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Mastectomy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
J4238TXMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Dallas Surgical Specialists, PA Surgery CurrentSince May 1, 1998 Accepting new patients
Healthtexas Provider Network Past Accepting new patients

Locations

700 Walter Reed Blvd
Ste 311
Garland, TX 75042
Phone 972487640026

3600 Shire Blvd
Ste 104
Richardson, TX 75082

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

Hospital & facility affiliations 2

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": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1558312504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 SHIRE BLVD STE 104",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750822236",
            "telephone_number": "972-487-6400",
            "fax_number": "972-487-1686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 SHIRE BLVD STE 104",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750822236",
            "telephone_number": "972-487-6400",
            "fax_number": "972-487-1686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "WALTER",
        "middle_name": "STUART",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "J4238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "88720G",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125237104",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richardson, TX

Sources for this page

Verify at the official NPI Registry.