Roberta May Johnson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

171502 Issued in NY

Practice address

249 RT. 11 a
Nedrow, NY 13120-4500

Phone

(315) 469-6994

Fax

(315) 469-0593

NPI assigned

Apr 13, 2009

Last updated

Apr 13, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Upstate Family and Preventive Medicine, Inc

  • Family Medicine Physician
  • Syracuse, NY
  • NPI 1073988911
  NPD (past)

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

{
    "created_epoch": "1239580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239580800000",
    "number": "1649413287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "249 RT 11A",
            "address_2": "ONONDAGA NATION HEALTH CLINIC",
            "city": "NEDROW",
            "state": "NY",
            "postal_code": "131204500",
            "telephone_number": "315-469-6994",
            "fax_number": "315-469-0593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "249 RT. 11 A",
            "city": "NEDROW",
            "state": "NY",
            "postal_code": "131204500",
            "telephone_number": "315-469-6994",
            "fax_number": "315-469-0593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ROBERTA",
        "middle_name": "MAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-13",
        "last_updated": "2009-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "171502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Cathcart, NP
• Daniel Eldon Frisch, P.T.A.
• Nakisha Graves
• Eva Dautenhahn Gregory, M.D.
• Marie L. Hayes, SLP
• Carol Anne Kozik, FNP
• Brigitte Lee
• Emma Lingo, FNP-BC
• Megan Floris Luton, S.L.P.
• Maxine Anne Malone, LPN

• Family Medicine Physician in Nedrow, NY
• Providers in Nedrow, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.