Millard E. Johnson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A62787 Issued in CA

Practice address

1510 Florida Ave
Suite F
Modesto, CA 95350-4437

Phone

(209) 549-7090

Fax

(209) 549-7099

NPI assigned

Nov 22, 2005

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 2

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles (20 of 21)

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: mjohnson33673@hisp.ehr.sutterhealth.org

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.

• Family First Medical Care a Professional Corporation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1689066029

  CA

  Medicare reassignment NPD
• Golden Valley Health Centers

  • Federally Qualified Health Center (FQHC)
  • Turlock, CA
  • NPI 1356445753

  CA

  Medicare reassignment NPD
• Family First Medical Care a Professional Corporation

  • Durable Medical Equipment & Medical Supplies
  • Modesto, CA
  • NPI 1699639070
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Planada, CA
  • NPI 1235114745
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Modesto, CA
  • NPI 1346224417
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Le Grand, CA
  • NPI 1356325310
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Merced, CA
  • NPI 1508333253
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Modesto, CA
  • NPI 1518298306
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Merced, CA
  • NPI 1528042512
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Newman, CA
  • NPI 1689658668
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Los Banos, CA
  • NPI 1730163734
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Dos Palos, CA
  • NPI 1770567778
  NPD

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1730162892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 W CHILDS AVE",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953406805",
            "telephone_number": "209-385-5529",
            "fax_number": "209-384-3966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 FLORIDA AVE",
            "address_2": "SUITE F",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504437",
            "telephone_number": "209-549-7090",
            "fax_number": "209-549-7099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MILLARD",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-22",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A62787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD CERT #",
            "identifier": "061924",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA PIN",
            "identifier": "00A627870",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margie Rae Johnson, PEER SUPPORT SPECIAL
• Marie Antoinette Johnson
• Marne Burch Johnson, NP-C
• Melonie Johnson
• Mercedes Johnson
• Natalia Johnson
• Nicole Johnson, LMFT, CSAT
• Rebecca Marie Johnson
• Scott Patrick Johnson, A.T.,C
• Shantel Denise Johnson

• All providers in Modesto, CA
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.