Individual provider Active NPI

Karen Diane Johnson, MD

  • Family Medicine Physician
  • Salem, OR
National Provider Identifier
1689674996
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD14151 Issued in OR
Practice address
1275 Wallace Rd NW
Salem, OR 97304-3007
Phone
(503) 371-3232
Fax
(503) 375-2398
NPI assigned
Jul 28, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD14151 OR Primary

Addresses

Primary practice location

1275 Wallace Rd NW
Salem, OR 97304-3007

Mailing address

1275 Wallace Rd NW
Salem, OR 97304-3007
Phone (503) 371-3232

Other identifiers 1

IdentifierTypeStateIssuer
105890MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
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
I20170915002702 HI Order and Referring Only - Family PracticePractitioner - Family Practice 9335199405

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192579200000",
    "number": "1689674996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 WALLACE RD NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973043007",
            "telephone_number": "503-371-3232",
            "fax_number": "503-375-2398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 WALLACE RD NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973043007",
            "telephone_number": "503-371-3232",
            "fax_number": "503-375-2398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KAREN",
        "middle_name": "DIANE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-28",
        "last_updated": "2007-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD14151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105890",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.