Individual provider Active NPI

Randy M Johnson, MD

  • Emergency Medicine Physician
  • Barberton, OH
National Provider Identifier
1700813490
Registry record updated Jul 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
35-087639 Issued in OH
Practice address
155 5TH St NE
Barberton, OH 44203-3332
Phone
(330) 493-4443
Fax
(330) 493-8677
NPI assigned
Jun 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 35-087639 OH Primary
Emergency Medicine Physician 207P00000X 35087639 OH

Addresses

Primary practice location

155 5TH St NE
Barberton, OH 44203-3332

Mailing address

2600 Sixth St SW
Canton, OH 44710-1702
Phone (330) 456-2695

Other practice location 1

2600 Sixth St SW
Canton, OH 44710-1702
Phone (330) 456-2695

Other identifiers 1

IdentifierTypeStateIssuer
2662533MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Randy.Johnson@direct.aultman.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20060801000011 OH Practitioner - Emergency Medicine 3375556780 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Medical College of Ohio, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Canton Aultman Emergency Physicians IncGroup PAC ID 2961307319, 24 clinicians

Practice addresses (Care Compare)

2600 6TH St SW
Canton, OH 44710-1702
Phone (330) 456-2695

Hospital & facility affiliations

  • Aultman Hospital Hospital, Canton, OH, CCN 360084

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35-087639OHMDEmergency Medicine Physician
35087639OHMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Canton Aultman Emergency Physicians Inc Emergency Medicine CurrentSince Jul 1, 2007 Accepting new patients
Caep-Dunlap, LLC Emergency Medicine CurrentSince Dec 1, 2009 Accepting new patients
Aultman Hospital CurrentSince Jul 1, 2007 Accepting new patients
Stark County Pathologists Inc Current Accepting new patients
Aultman Hospital CurrentSince Jul 1, 2007 Accepting new patients
Ohio Emergency Medicine Specialists, LLC Emergency Medicine CurrentSince Aug 1, 2018 Accepting new patients
Emergency Medicine Physicians of Wadsworth, LTD. Emergency Medicine Past Accepting new patients

Locations

200 E State St
Alliance, OH 44601
Phone (330) 596-6000

2600 6th St SW
Canton, OH 44710
Phone (330) 363-2180

2600 6th St SW
#L
Canton, OH 44710

832 S Main St
Orrville, OH 44667
Phone (330) 456-2695

Interoperability endpoints

  • Direct secure messaging: randy.johnson@direct.aultman.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656633600000",
    "number": "1700813490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 SIXTH ST SW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447101702",
            "telephone_number": "330-456-2695",
            "fax_number": "330-588-8605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 5TH ST NE",
            "city": "BARBERTON",
            "state": "OH",
            "postal_code": "442033332",
            "telephone_number": "330-493-4443",
            "fax_number": "330-493-8677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2600 Sixth St SW",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "OH",
            "postal_code": "447101702",
            "country_code": "US",
            "telephone_number": "330-456-2695",
            "fax_number": "330-588-8605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "RANDY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2022-07-01",
        "certification_date": "2022-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35-087639",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35087639",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2662533",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Randy.Johnson@direct.aultman.org",
            "affiliation": "N",
            "address_1": "2600 Sixth St SW",
            "city": "Canton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "447101702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Barberton, OH

Sources for this page

Verify at the official NPI Registry.