Individual provider Active NPI

David O Johnson, M.D.

  • Pediatrics Physician
  • Southlake, TX
National Provider Identifier
1740204692
Registry record updated Jun 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
E4432 Issued in TX
Practice address
731 E Southlake Blvd
Suite 100
Southlake, TX 76092-6377
Phone
(817) 912-8800
Fax
(817) 912-8810
NPI assigned
Jul 26, 2006
Last updated
Jun 11, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X E4432 TX Primary

Addresses

Primary practice location

731 E Southlake Blvd
Suite 100
Southlake, TX 76092-6377

Mailing address

731 E Southlake Blvd
Suite 100
Southlake, TX 76092-6377
Phone (817) 912-8800

Other identifiers 2

IdentifierTypeStateIssuer
1378663-01MedicaidTX
88X564OtherTXBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20100512000102 TX Practitioner - Pediatric Medicine 1355479486 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Jan 19, 2010 Accepting new patients
Healthtexas Provider Network CurrentSince Jan 19, 2010 Accepting new patients
Healthtexas Provider Network Pediatrics Current Accepting new patients

Locations

5408 Colleyville Blvd
Colleyville, TX 76034
Phone (817) 498-9920

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

8080 N Central Expy
Ste 600
Dallas, TX 75206
Phone (469) 800-8648

731 E Southlake Blvd
Ste 100
Southlake, TX 76092
Phone (817) 424-3366

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433980800000",
    "number": "1740204692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 E SOUTHLAKE BLVD",
            "address_2": "SUITE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926377",
            "telephone_number": "817-912-8800",
            "fax_number": "817-912-8810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 E SOUTHLAKE BLVD",
            "address_2": "SUITE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926377",
            "telephone_number": "817-912-8800",
            "fax_number": "817-912-8810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DAVID",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2015-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "E4432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1378663-01",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "88X564",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

Verify at the official NPI Registry.