NPIMap

Individual provider Active NPI

Jennifer Myia Johnson, M.D.

  • Family Medicine Physician
  • Boulder, CO
National Provider Identifier
1710006382
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
43964 Issued in CO
Practice address
2880 Folsom St Ste 100
Boulder, CO 80304-3769
Phone
(303) 327-7047
Fax
(303) 443-7168
NPI assigned
Mar 28, 2007
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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 43964 CO Primary

Addresses

Primary practice location

2880 Folsom St Ste 100
Boulder, CO 80304-3769

Mailing address

PO Box 1628
Longmont, CO 80502-1628
Phone (303) 651-5139

Other identifiers 1

IdentifierTypeStateIssuer
56929340MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070723000808 CO Practitioner - Family Practice 9638270499 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Colorado School of Medicine, Denver, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Boulder Internal Medicine PCGroup PAC ID 0840282422, 5 clinicians

Practice addresses (Care Compare)

2880 Folsom St
Suite 100
Boulder, CO 80304-3769

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43964COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Internal Medicine PC Family Medicine CurrentSince Jul 30, 2019 Accepting new patients
Clinica Campesina Family Health Services Past Accepting new patients

Locations

2880 Folsom St
Ste 100
Boulder, CO 80304
Phone (303) 247-9696

Interoperability endpoints

  • Direct secure messaging: jennifer.johnson.d1.p4@direct.clinicafamilyhealth.nextgenshare.com
  • Direct secure messaging: jennifer.johnson@5176137285636.direct.elationemr.com
  • Direct secure messaging: jennifer.johnson@bimpc.eclinicaldirectplus.com

Organizations & group practices 2

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.

Hospital & facility affiliations 62

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

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1710006382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1628",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805021628",
            "telephone_number": "303-651-5139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2880 FOLSOM ST STE 100",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803043769",
            "telephone_number": "303-327-7047",
            "fax_number": "303-443-7168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JENNIFER",
        "middle_name": "MYIA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-28",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "43964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "56929340",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.