Individual provider Active NPI

Misty L Johnson, MD

  • Hospitalist Physician
  • Fond Du Lac, WI
National Provider Identifier
1578557146
Registry record updated Aug 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
35760 Issued in WI
Practice address
210 Wisconsin American Dr
Fond Du Lac, WI 54937-2999
Phone
(920) 907-7500
NPI assigned
Sep 9, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35760 WI
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 35760 WI
Hospitalist Physician 208M00000X 35760 WI Primary

Addresses

Primary practice location

210 Wisconsin American Dr
Fond Du Lac, WI 54937-2999

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other practice location 1

1506 S Oneida St
Appleton, WI 54915-1305
Phone (920) 738-2000

Other identifiers 1

IdentifierTypeStateIssuer
32249300MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mjohnson403551@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20100604000951 WI Practitioner - HospitalistPractitioner - Internal Medicine 0244360089 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
University of Toledo College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

210 Wisconsin American Dr
Fond Du Lac, WI 54937-2999
Phone (920) 907-4800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35760WIMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Jun 29, 2024 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Jun 29, 2024 Accepting new patients
Aurora Medical Group, Inc. Internal Medicine Current Accepting new patients

Locations

210 Wisconsin American Dr
Fond du Lac, WI 54937
Phone (920) 907-7000

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220

Interoperability endpoints

  • Direct secure messaging: mjohnson403551@direct.myadvocateaurora.org

Organizations & group practices 3

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 1

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": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722556800000",
    "number": "1578557146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 WISCONSIN AMERICAN DR",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549372999",
            "telephone_number": "920-907-7500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1506 S Oneida St",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549151305",
            "country_code": "US",
            "telephone_number": "920-738-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MISTY",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-09",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "35760",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "WI",
            "license": "35760",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WI",
            "license": "35760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32249300",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mjohnson403551@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "210 Wisconsin American Dr",
            "city": "Fond Du Lac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549372999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "210 Wisconsin American Dr",
            "city": "Fond Du Lac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549372999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

Verify at the official NPI Registry.