Richard A Johnson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G37531 Issued in CA

Practice address

15200 W Sunset Blvd Ste 107
Pacific Palisades, CA 90272-3620

Phone

(310) 459-7736

Fax

(310) 230-0284

NPI assigned

Aug 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Pacific Palisades Medical Group Inc.

  • Family Medicine Physician
  • Pacific Palisades, CA
  • NPI 1215037049
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355270400000",
    "number": "1770596009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15200 W SUNSET BLVD STE 107",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902723620",
            "telephone_number": "310-459-7736",
            "fax_number": "310-230-0284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15200 W SUNSET BLVD STE 107",
            "city": "PACIFIC PALISADES",
            "state": "CA",
            "postal_code": "902723620",
            "telephone_number": "310-459-7736",
            "fax_number": "310-230-0284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "RICHARD",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2012-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G37531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G375310",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gary Allan Jacob, DC
• Nina Karlin Jacob, MFT
• Tanya Jacob, PHD
• Richard Leslie Jacobson, D.M.D, M.S.
• Frank Jasper, L.AC
• Arielle Erin Jones
• K&a Psychological Services Inc
• Barbara Kagan, P.T.
• Ryan L. Kahanu, DPT
• Kalea Medspa PC

• Family Medicine Physician in Pacific Palisades, CA
• Providers in Pacific Palisades, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2012; 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.

Verify at the official NPI Registry.