NPIMap

Organization Active NPI

Michael W Johnson, MD, PC

  • Surgery Physician
  • Petoskey, MI
National Provider Identifier
1730269630
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301054807 Issued in MI
Legal business name
MICHAEL W JOHNSON, MD, PC
Practice address
101 W Mitchell St
Petoskey, MI 49770-2323
Phone
(231) 487-1000
Fax
(231) 487-1002
NPI assigned
Oct 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Tina Bays
Title
Office Manager
Phone
(231) 487-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 4301054807 MI Primary

Addresses

Primary practice location

101 W Mitchell St
Petoskey, MI 49770-2323

Mailing address

101 W Mitchell St
Petoskey, MI 49770-2323
Phone (231) 487-1000

Other identifiers 6

IdentifierTypeStateIssuer
21407OtherMIMOLINA
MJ054807OtherMISTATE LICENSE W/INITIALS
221490-0001OtherMISELECTCARE
1015064OtherMINORTHERN HEALTH PLAN
0202410071OtherMIBCBSM PROVIDER ID #
4301054807OtherMISTATE LICENSE

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730269630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W MITCHELL ST",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702323",
            "telephone_number": "231-487-1000",
            "fax_number": "231-487-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W MITCHELL ST",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702323",
            "telephone_number": "231-487-1000",
            "fax_number": "231-487-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL W JOHNSON, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAYS",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "231-487-1000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301054807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA",
            "identifier": "21407",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE W/INITIALS",
            "identifier": "MJ054807",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECTCARE",
            "identifier": "221490-0001",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTHERN HEALTH PLAN",
            "identifier": "1015064",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM PROVIDER ID #",
            "identifier": "0202410071",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "4301054807",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.