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Individual provider Active NPI

Gabriel Hayden Johnson, DO

  • Diagnostic Radiology Physician
  • Pueblo, CO
National Provider Identifier
1558523878
Registry record updated Jun 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2018-00655 Issued in NC
Practice address
1008 Minnequa Ave
Pueblo, CO 81004-3733
Phone
(719) 584-7410
NPI assigned
Jun 27, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 48004 CO
General Practice Physician 208D00000X 48004 CO
Diagnostic Radiology Physician 2085R0202X 2018-00655 NC Primary

Addresses

Primary practice location

1008 Minnequa Ave
Pueblo, CO 81004-3733

Mailing address

PO Box 7693
Loveland, CO 80537-0693
Phone (706) 632-7429

Other practice location 1

11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438
Phone (315) 774-1451

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200622001394 CO Practitioner - Diagnostic Radiology 0547483000 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Lake Erie College of Osteopathic Medicine, Erie, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pueblo Radiological Group PCGroup PAC ID 5597661272, 7 clinicians

Practice addresses (Care Compare)

1008 Minnequa Ave
Pueblo, CO 81004-3733
Phone (719) 560-5592

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
48004COMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pueblo Radiological Group PC Diagnostic Radiology CurrentSince May 25, 2020 Accepting new patients
Pueblo Radiological Group, P.C. Diagnostic Radiology PastSince Nov 8, 2020 Accepting new patients

Locations

933 Sell Ave
Canon City, CO 81212
Phone (719) 275-6433

3245 E US Highway 50
Unit E
Canon City, CO 81212
Phone (719) 285-2700

4112 Outlook Blvd
Ste 37
Pueblo, CO 81008
Phone (719) 562-6254

1020 Lakeview Ave
Pueblo, CO 81004
Phone (719) 557-3145

1008 Minnequa Ave
Pueblo, CO 81004
Phone (719) 557-5656

4112 Outlook Blvd
Ste 255
Pueblo, CO 81008
Phone (719) 253-7640

4112 Outlook Blvd
Ste 96
Pueblo, CO 81008
Phone (719) 562-6200

2035 S Pueblo Blvd
Pueblo, CO 81005
Phone (719) 299-4819

729 E Spaulding Ave
Pueblo West, CO 81007
Phone (719) 285-2735

23500 US Highway 160
Walsenburg, CO 81089
Phone (719) 738-5100

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591142400000",
    "number": "1558523878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7693",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805370693",
            "telephone_number": "706-632-7429",
            "fax_number": "970-342-2093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 MINNEQUA AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043733",
            "telephone_number": "719-584-7410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11050 Mount Belvedere Blvd",
            "address_purpose": "LOCATION",
            "city": "Fort Drum",
            "state": "NY",
            "postal_code": "136025438",
            "country_code": "US",
            "telephone_number": "315-774-1451",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "GABRIEL",
        "middle_name": "HAYDEN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-27",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CO",
            "license": "48004",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CO",
            "license": "48004",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2018-00655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.