Active NPI
Michael Shane Johnson, M.D.
- General Practice Physician
- Oklahoma City, OK
National Provider Identifier
1770877151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 30380
- Practice address
- 13600 Prairie View LN
Oklahoma City, OK 73142-5917 - Phone
- (888) 330-7831
- NPI assigned
- Jun 3, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 30380 | OK | Primary |
Addresses
Primary practice location
13600 Prairie View LN
Oklahoma City, OK 73142-5917
Mailing address
13600 Prairie View LN
Oklahoma City, OK 73142-5917
Phone (888) 330-7831
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30380 | OK | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1396310400000",
"number": "1770877151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13600 PRAIRIE VIEW LN",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731425917",
"telephone_number": "888-330-7831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13600 PRAIRIE VIEW LN",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731425917",
"telephone_number": "888-330-7831"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MICHAEL",
"middle_name": "SHANE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-03",
"last_updated": "2014-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "OK",
"license": "30380",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.