Active NPI
Jeffrey R Johnson, MD
- Surgery Physician
- East Lansing, MI
National Provider Identifier
1730160904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 4301042405
- Practice address
- 1675 Watertower Place
Suite 100
East Lansing, MI 48823 - Phone
- (517) 332-0200
- Fax
- (517) 332-0963
- NPI assigned
- Nov 7, 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 4301042405 | MI | Primary |
Addresses
Primary practice location
1675 Watertower Place
Suite 100
East Lansing, MI 48823
Mailing address
1675 Watertower Place
Suite 100
East Lansing, MI 48823
Phone (517) 332-0200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3493103 | Medicaid | MI |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184198400000",
"number": "1730160904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1675 WATERTOWER PLACE",
"address_2": "SUITE 100",
"city": "EAST LANSING",
"state": "MI",
"postal_code": "48823",
"telephone_number": "517-332-0200",
"fax_number": "517-332-0963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1675 WATERTOWER PLACE",
"address_2": "SUITE 100",
"city": "EAST LANSING",
"state": "MI",
"postal_code": "48823",
"telephone_number": "517-332-0200",
"fax_number": "517-332-0963"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JEFFREY",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-07",
"last_updated": "2007-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MI",
"license": "4301042405",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3493103",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Lansing, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.