NPIMap

Individual provider Active NPI

Timothy David Johnston, M.D.

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1760416242
Registry record updated Nov 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD429536 Issued in PA
Practice address
4417 N 6TH St
Philadelphia, PA 19140-2319
Phone
(215) 302-3150
Fax
(215) 329-2369
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD429536 PA Primary
Pediatrics Physician 208000000X MD429536 PA

Addresses

Primary practice location

4417 N 6TH St
Philadelphia, PA 19140-2319

Mailing address

4417 N 6TH St
Philadelphia, PA 19140-2319
Phone (215) 302-3150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070515000601 PA Practitioner - Internal MedicinePractitioner - Pediatric Medicine 5496783433 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Indiana University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Esperanza Health Center, Inc.Group PAC ID 6103815071, 32 clinicians

Practice addresses (Care Compare)

4417 N 6TH St
Philadelphia, PA 19140-2319
Phone (215) 302-3600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD429536PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Esperanza Health Center, Inc. CurrentSince Oct 2, 2006 Accepting new patients
Esperanza Health Center, Inc. CurrentSince Oct 2, 2006 Accepting new patients
Temple University Hospital, Inc Past Accepting new patients
Wakemed Faculty Practice Plan Internal Medicine Past Accepting new patients
Esperanza Health Center, Inc. Past Accepting new patients
Wakemed Faculty Practice Plan Past Accepting new patients

Locations

4417 N 6th St
Philadelphia, PA 19140
Phone (215) 302-3150

861 E Allegheny Ave
Philadelphia, PA 19134
Phone (215) 302-3600

Organizations & group practices 6

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416355200000",
    "number": "1760416242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4417 N 6TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191402319",
            "telephone_number": "215-302-3150",
            "fax_number": "215-329-2369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4417 N 6TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191402319",
            "telephone_number": "215-302-3150",
            "fax_number": "215-329-2369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "TIMOTHY",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2014-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD429536",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD429536",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.