Active NPI
Paul Jennings Johnson, MD
- Family Medicine Physician
- Bend, OR
National Provider Identifier
1699774877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD13627
- Practice address
- 929 SW Simpson Ave
Suite 300
Bend, OR 97702-3599 - Phone
- (541) 389-7741
- Fax
- (541) 278-8376
- NPI assigned
- Jul 19, 2005
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD13627 | OR | Primary |
Addresses
Primary practice location
929 SW Simpson Ave
Suite 300
Bend, OR 97702-3599
Mailing address
PO Box 670
Bend, OR 97709-0670
Phone (541) 389-7741
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 284323 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD13627 | OR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459209600000",
"number": "1699774877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 670",
"city": "BEND",
"state": "OR",
"postal_code": "977090670",
"telephone_number": "541-389-7741",
"fax_number": "541-278-8376"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "929 SW SIMPSON AVE",
"address_2": "SUITE 300",
"city": "BEND",
"state": "OR",
"postal_code": "977023599",
"telephone_number": "541-389-7741",
"fax_number": "541-278-8376"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "PAUL",
"middle_name": "JENNINGS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-19",
"last_updated": "2016-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "MD13627",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "284323",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.