Individual provider Active NPI

Dane George Johnson, DPT

  • Physical Therapist
  • Upland, CA
National Provider Identifier
1639750326
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
400 N Mountain Ave Ste 310
Upland, CA 91786-5182
Phone
(909) 920-6457
NPI assigned
Apr 15, 2021
Last updated
Apr 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X CA Primary

Addresses

Primary practice location

400 N Mountain Ave Ste 310
Upland, CA 91786-5182

Mailing address

11068 Shiloh CT
Rancho Cucamonga, CA 91737-7810
Phone (909) 767-2843

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210601002446 CA Practitioner - Physical Therapist in Private Practice 6305245945 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Center for Bone and Joint DisordersGroup PAC ID 6709836844, 3 clinicians

Practice addresses (Care Compare)

400 N Mountain Ave
Suite 310
Upland, CA 91786-5182
Phone (909) 920-0876

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Center for Bone and Joint Disorders CurrentSince Apr 5, 2021 Accepting new patients

Locations

8045 Archibald Ave
Ste 100
Rch Cucamonga, CA 91730
Phone (909) 920-0876

400 N Mountain Ave
Ste 310
Upland, CA 91786
Phone (909) 920-0876

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1618444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618444800000",
    "number": "1639750326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11068 SHILOH CT",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917377810",
            "telephone_number": "909-767-2843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N MOUNTAIN AVE STE 310",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917865182",
            "telephone_number": "909-920-6457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DANE",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-15",
        "last_updated": "2021-04-15",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.