Antoine D Johnson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00039048 Issued in WA

Practice address

105 W. 4TH Street
Aberdeen, WA 98520

Phone

(360) 538-7292

Fax

(360) 533-7135

NPI assigned

Apr 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Broadway Clinic Inc

  • Family Medicine Physician
  • Aberdeen, WA
  • NPI 1548370547

  Family Medicine

  NPD (past) Authorized official
• Pacific County Hospital District 2

  • Critical Access Hospital
  • South Bend, WA
  • NPI 1295708683
  NPD (past)
• Plateau Emergency Physicians

  • Emergency Medicine Physician
  • Enumclaw, WA
  • NPI 1497785315
  NPD (past)
• Quinault Indian Nation

  • Rural Health Clinic/Center
  • Taholah, WA
  • NPI 1093888547
  NPD (past)
• Shoalwater Bay Tribe

  • Primary Care Clinic/Center
  • Tokeland, WA
  • NPI 1063624740
  NPD (past)

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639136294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 149",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985200063",
            "telephone_number": "360-538-7292",
            "fax_number": "360-533-2566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 W. 4TH STREET",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "98520",
            "telephone_number": "360-538-7292",
            "fax_number": "360-533-7135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ANTOINE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00039048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8270787",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cynthia Jean Jensen, MSW, MHP, CDP, RC
• Jessica Pierce, M.D., P.S.
• David C Jester, D.O.
• John Bausher MD PHD PS
• John J Miller MD PS
• Brooklynne Johnson, AA
• Megan Elizabeth Johnson
• Stacey Johnson, BA
• Star Marie Johnson, SUDP
• Terry David Johnson

• All providers in Aberdeen, WA
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.