Active NPI
Mark Johnson
- Surgery Physician
- Atlanta, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- ME124207
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 015133000 | Medicaid | FL |
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
Enrollment records 1
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
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
| License | State | Type | Specialty |
|---|---|---|---|
| 055843 | GA | MD | Transplant Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Halifax Healthcare Systems Inc | Transplant Surgery | Current | Accepting new patients |
| Florida Clinical Practice Association Inc | Surgery | Current | Accepting new patients |
| Florida Clinical Practice Association Inc | Current | Accepting new patients | |
| Piedmont Healthcare Inc | Past | 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
- mjohnson184108@direct.shands.ufl.edu
- 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.
-
dba HHCSI Halifax Family Health Center
- Family Medicine Physician
- Daytona Beach, FL
- NPI 1245283530
Transplant Surgery
-
dba UF Health Physicians
- Surgery Physician
- Gainesville, FL
- NPI 1063463768
-
dba UF Health Family Medicine Ocala Heath Brook
- Durable Medical Equipment & Medical Supplies
- Ocala, FL
- NPI 1609529478
-
- Cardiovascular Disease Physician
- Stockbridge, GA
- NPI 1376624940
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba AdventHealth Orlando
- General Acute Care Hospital
- Orlando, FL
- NPI 1306938071
-
dba AdventHealth Orlando Outreach Laboratory
- Clinical Medical Laboratory
- Orlando, FL
- NPI 1801569728
Hospital
-
dba Halifax Medical Center
- General Acute Care Hospital
- Daytona Beach, FL
- NPI 1811991227
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.