Active NPI
Justin Johannesen, M.D.
- Cardiovascular Disease Physician
- New York, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 310559
- Practice address
- 177 Fort Washington Ave
New York, NY 10032-3733 - Phone
- (212) 305-9875
- Fax
- (212) 305-9049
- NPI assigned
- Jul 16, 2013
- Last updated
- May 27, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD457605 | PA | |
| Cardiovascular Disease Physician | 207RC0000X | 310559 | NY | Primary |
Addresses
Primary practice location
177 Fort Washington Ave
New York, NY 10032-3733
Mailing address
177 Fort Washington Ave
New York, NY 10032-3733
Phone (212) 305-9875
Other practice location 1
245 N 15th St
Philadelphia, PA 19102-1101
Phone (215) 762-7698
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA, NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- Drexel University College of Medicine, 2013
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
111 E 210TH St
Bronx, NY 10467-2401
Phone (866) 633-8255
3400 Bainbridge Ave
Bronx, NY 10467-2404
Phone (914) 378-6148
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 310559 | NY | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Montefiore Medical Center | Internal Medicine | Current | Accepting new patients |
| Montefiore Medical Center | Current | Accepting new patients | |
| Tower Health Medical Group | Current | Accepting new patients | |
| Trustees of Columbia University in the City of New York | Internal Medicine | Current | Accepting new patients |
| Tower Health Medical Group | Internal Medicine | Current | Accepting new patients |
| Trustees of Columbia University in the City of New York | Internal Medicine | Current | Accepting new patients |
| Tower Health Medical Group | Current | Accepting new patients | |
| Nazareth Physician Services, Inc | Past | Accepting new patients | |
| Montefiore Medical Center | Past | Accepting new patients |
Locations
111 E 210th St
Bronx, NY 10467
161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559
177 Fort Washington Ave
New York, NY 10032
Phone (212) 305-3090
622 W 168th St
New York, NY 10032
Phone (212) 305-4931
301 S 7th Ave
Ste 130
West Reading, PA 19611
Phone (610) 988-4630
6 Spruce St
West Reading, PA 19611
Phone (484) 628-8269
2610 Keiser Blvd
Wyomissing, PA 19610
Phone (484) 628-9127
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
Interoperability endpoints
- https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
- https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
- jjohannese@montefioredirect.com
- jjohannesen19610@epicdirect.rwjbh.org
Organizations & group practices 9
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.
-
- Surgery Physician
- New York, NY
- NPI 1508266347
Internal Medicine
-
dba Internal Medicine - Tower Health Medical Group
- Internal Medicine Physician
- Birdsboro, PA
- NPI 1609291350
-
dba Montefiore Community Pharmacy @ CHAM
- Community/Retail Pharmacy
- Bronx, NY
- NPI 1194183715
-
- Internal Medicine Physician
- New York, NY
- NPI 1699289488
-
dba Education Fund West Reading Tower Health Medical Group
- Obstetrics & Gynecology Physician
- West Reading, PA
- NPI 1427149335
-
dba Breast Health Center Wyomissing Tower Health Medical Group
- Surgery Physician
- Wyomissing, PA
- NPI 1831954353
-
- General Acute Care Hospital
- Bronx, NY
- NPI 1952476988
-
- Family Medicine Physician
- Philadelphia, PA
- NPI 1215452982
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Bronx, NY
- NPI 1952476988
-
- General Acute Care Hospital
- Nyack, NY
- NPI 1104808062
-
- General Acute Care Hospital
- Yonkers, NY
- NPI 1578526695
-
dba White Plains Hospital Center
- General Acute Care Hospital
- White Plains, NY
- NPI 1447255153
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653609600000",
"number": "1700227949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "177 FORT WASHINGTON AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323733",
"telephone_number": "212-305-9875",
"fax_number": "212-305-9049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "177 FORT WASHINGTON AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323733",
"telephone_number": "212-305-9875",
"fax_number": "212-305-9049"
}
],
"practiceLocations": [
{
"address_1": "245 N 15th St",
"address_purpose": "LOCATION",
"city": "Philadelphia",
"state": "PA",
"postal_code": "191021101",
"country_code": "US",
"telephone_number": "215-762-7698",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JOHANNESEN",
"first_name": "JUSTIN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-07-16",
"last_updated": "2022-05-27",
"certification_date": "2022-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "MD457605",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "NY",
"license": "310559",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; 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.