Active NPI
Rose Mary Johnson, D.D.S.
- Dentist
- Jacksonville, FL
National Provider Identifier
1750831087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN21954
- Practice address
- 7740 Point Meadows Dr Ste 4
Jacksonville, FL 32256-9180 - Phone
- (720) 467-9222
- NPI assigned
- Oct 11, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | DN21954 | FL | Primary |
Addresses
Primary practice location
7740 Point Meadows Dr Ste 4
Jacksonville, FL 32256-9180
Mailing address
4122 Seabreeze Drive
Jacksonville Beach, FL 32250
Phone (720) 467-9222
Other practice location 1
1023 Atlantic Blvd
Atlantic Beach, FL 32233-3313
Phone (904) 249-3104
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161117000587 | FL | Order and Referring Only - Dentist | 4688953599 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN21954 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565049600000",
"number": "1750831087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4122 SEABREEZE DRIVE",
"city": "JACKSONVILLE BEACH",
"state": "FL",
"postal_code": "32250",
"telephone_number": "720-467-9222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7740 POINT MEADOWS DR STE 4",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322569180",
"telephone_number": "720-467-9222"
}
],
"practiceLocations": [
{
"address_1": "1023 Atlantic Blvd",
"address_purpose": "LOCATION",
"city": "Atlantic Beach",
"state": "FL",
"postal_code": "322333313",
"country_code": "US",
"telephone_number": "904-249-3104",
"fax_number": "904-249-3109",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JOHNSON",
"first_name": "ROSE",
"middle_name": "MARY",
"name_prefix": "Ms.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-11",
"last_updated": "2019-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN21954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; 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.