Active NPI
Susan Dwyer Johnston, FNP
- Nurse Practitioner
- Indianapolis, IN
National Provider Identifier
1730211467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 71002617A
- Practice address
- 1001 W 10TH St
Indianapolis, IN 46202-2859 - Phone
- (317) 630-7243
- NPI assigned
- Mar 9, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 71002617A | IN | Primary |
Addresses
Primary practice location
1001 W 10TH St
Indianapolis, IN 46202-2859
Mailing address
8910 Purdue Rd
Ste.500
Indianapolis, IN 46268-6100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000585282 | Other | IN | ANTHEM |
| 200509970 | Medicaid | IN |
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)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71002617A | IN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227139200000",
"number": "1730211467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8910 PURDUE RD",
"address_2": "STE.500",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462686100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 W 10TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462022859",
"telephone_number": "317-630-7243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSTON",
"first_name": "SUSAN",
"middle_name": "DWYER",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-09",
"last_updated": "2008-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "71002617A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000585282",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200509970",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.