William Roy Karl Johnson, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

22859 Issued in CT

Practice address

612 Hartford Pike
Medical Center of Northeast Connecticut
Dayville, CT 06241

Phone

(860) 779-0867

Fax

(860) 779-0386

NPI assigned

Nov 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Medical Center of Northeast Connecticut

  • Internal Medicine Physician
  • Dayville, CT
  • NPI 1194915314
  NPD (past)

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289347200000",
    "number": "1710057351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 HARTFORD PIKE",
            "address_2": "MEDICAL CENTER OF NORTHEAST CONNECTICUT",
            "city": "DAYVILLE",
            "state": "CT",
            "postal_code": "06241",
            "telephone_number": "860-779-0867",
            "fax_number": "860-779-0386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 HARTFORD PIKE",
            "address_2": "MEDICAL CENTER OF NORTHEAST CONNECTICUT",
            "city": "DAYVILLE",
            "state": "CT",
            "postal_code": "06241",
            "telephone_number": "860-779-0867",
            "fax_number": "860-779-0386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "WILLIAM",
        "middle_name": "ROY KARL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2010-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "22859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001228592",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen A Hucknall, M.A.
• Humming Into Wellness LLC
• Madalyn Ide, ATC
• Deborah J Johnson, MSW
• Michael Scott Johnson, MSW
• Lauren Johnston, LMT
• Mena Johny
• Joseph Botta MD & Associates LLC
• Tera Juszczyk, MSW
• Nancy Kelly, LCSW

• Internal Medicine Physician in Dayville, CT
• Providers in Dayville, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.