Active NPI
Jason Johnson, M.D
- Emergency Medicine Physician
- Whiteriver, AZ
National Provider Identifier
1669517611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 40617
- Practice address
- 200 W. Hospital Dr.
Whiteriver, AZ 95491-0860 - Phone
- (928) 338-4911
- NPI assigned
- Feb 20, 2007
- Last updated
- Mar 13, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 40617 | AZ | Primary |
Addresses
Primary practice location
200 W. Hospital Dr.
Whiteriver, AZ 95491-0860
Mailing address
200 W. Hospital Dr.
Whiteriver, AZ 95491-0860
Phone (928) 338-4911
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295993376 | Medicaid | AZ | |
| 353135 | Medicaid | AZ | |
| 1427335181 | Medicaid | AZ | |
| 1427335140 | Medicaid | AZ | |
| 1629236716 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- 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
- Emergency Medicine
- Education
- University of North Dakota School of Medicine, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2200 E Show Low Lake Rd
Show Low, AZ 85901-7831
Phone (928) 537-4375
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40617 | AZ | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Healthcare Medical Associates | Current | Accepting new patients | |
| Summit Healthcare Association | Current | Accepting new patients | |
| Innova Emergency Medical Associates PC | Emergency Medicine | Current | Accepting new patients |
| Summit Healthcare Medical Associates | Current | Accepting new patients | |
| Covenant Medical Center, Inc | Past | Accepting new patients |
Locations
3269 N Stockton Hill Rd
Kingman, AZ 86409
Phone (928) 757-0626
2200 E Show Low Lake Rd
Show Low, AZ 85901
Phone (928) 537-4375
Interoperability endpoints
- jasonjohnson@shrmcshma.allscriptsdirect.net
Organizations & group practices 5
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.
-
dba Summit Healthcare Regional Medical Center
- Rural Acute Care Hospital
- Show Low, AZ
- NPI 1144209271
-
- Family Medicine Physician
- Show Low, AZ
- NPI 1467878108
-
- Rural Health Clinic/Center
- Eagar, AZ
- NPI 1063166999
-
- Family Medicine Physician
- Saginaw, MI
- NPI 1619412376
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Summit Healthcare Oncology Center
- Oncology Clinic/Center
- Show Low, AZ
- NPI 1083736128
Hospital
-
dba Summit Healthcare Regional Medical Center
- Rural Acute Care Hospital
- Show Low, AZ
- NPI 1144209271
-
dba Family Medicine at Bison Ranch
- Rural Health Clinic/Center
- Overgaard, AZ
- NPI 1770700767
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331596800000",
"number": "1669517611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 W. HOSPITAL DR.",
"city": "WHITERIVER",
"state": "AZ",
"postal_code": "954910860",
"telephone_number": "928-338-4911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 W. HOSPITAL DR.",
"city": "WHITERIVER",
"state": "AZ",
"postal_code": "954910860",
"telephone_number": "928-338-4911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JASON",
"credential": "M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-20",
"last_updated": "2012-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "AZ",
"license": "40617",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1295993376",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "353135",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1427335181",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1427335140",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1629236716",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Whiteriver, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2012; 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.