Active NPI
Joel Allen Johnson, NP-BC
- Family Nurse Practitioner
- Bend, OR
National Provider Identifier
1639416340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 201906220NP-PP
- Practice address
- 23861 Dodds Rd
Bend, OR 97701-9684 - Phone
- (541) 213-3473
- NPI assigned
- Jan 15, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 201906220NP-PP | OR | Primary |
Addresses
Primary practice location
23861 Dodds Rd
Bend, OR 97701-9684
Mailing address
2660 NE Hwy 20 Suite 610
FMB 100
Bend, OR 97701
Phone (305) 304-9201
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201906220NP-PP | OR | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708646400000",
"number": "1639416340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2660 NE HWY 20 SUITE 610",
"address_2": "FMB 100",
"city": "BEND",
"state": "OR",
"postal_code": "97701",
"telephone_number": "305-304-9201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23861 DODDS RD",
"city": "BEND",
"state": "OR",
"postal_code": "977019684",
"telephone_number": "541-213-3473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JOEL",
"middle_name": "ALLEN",
"credential": "NP-BC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-01-15",
"last_updated": "2024-02-23",
"certification_date": "2024-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OR",
"license": "201906220NP-PP",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.