Individual provider Active NPI

Mark Johnson

  • Surgery Physician
  • Atlanta, GA
National Provider Identifier
1649313909
Registry record updated Jul 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
ME124207 Issued in FL
Practice address
1968 Peachtree Rd NW
77 Building 5TH Floor
Atlanta, GA 30309-1281
Phone
(404) 605-4600
NPI assigned
Feb 15, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Transplant Surgery Physician 204F00000X 055843 GA
Surgery Physician 208600000X ME124207 FL Primary

Addresses

Primary practice location

1968 Peachtree Rd NW
77 Building 5TH Floor
Atlanta, GA 30309-1281

Mailing address

PO Box 102321
Atlanta, GA 30368-2321

Other identifiers 1

IdentifierTypeStateIssuer
015133000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20150805009223 FL Practitioner - General Surgery 5496706038 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Tufts University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Halifax Healthcare Systems IncGroup PAC ID 1254238090, 345 clinicians

Practice addresses (Care Compare)

311 N Clyde Morris Blvd
Suite 360
Daytona Beach, FL 32114-2766
Phone (386) 254-4199

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
055843GAMDTransplant Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Halifax Healthcare Systems Inc Transplant Surgery CurrentSince Aug 25, 2017 Accepting new patients
Florida Clinical Practice Association Inc Surgery CurrentSince Jul 1, 2015 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Jul 1, 2015 Accepting new patients
Piedmont Healthcare Inc PastSince Feb 3, 2010 Accepting new patients

Locations

311 N Clyde Morris Blvd
Ste 360
Daytona Beach, FL 32114
Phone (386) 254-4199

303 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 425-2285

1549 Gale Lemerand Dr
Gainesville, FL 32610
Phone (352) 265-0496

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

4800 Belfort Rd
Jacksonville, FL 32256
Phone (904) 307-2084

721 W Colonial Dr
Orlando, FL 32804
Phone (407) 245-8501

9430 Turkey Lake Rd
Ste 206
Orlando, FL 32819
Phone (407) 297-3626

5147 N 9th Ave
Ste 311
Pensacola, FL 32504

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: mjohnson184108@direct.shands.ufl.edu
  • Direct secure messaging: mark.johnson.1@9582.direct.athenahealth.com

Organizations & group practices 4

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 3

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": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436486400000",
    "number": "1649313909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102321",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303682321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1968 PEACHTREE RD NW",
            "address_2": "77 BUILDING 5TH FLOOR",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091281",
            "telephone_number": "404-605-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2015-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204F00000X",
            "taxonomy_group": "",
            "desc": "Transplant Surgery",
            "state": "GA",
            "license": "055843",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME124207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015133000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.