NPIMap

Individual provider Active NPI

Jerimiah Johnson, M.D.

  • Family Medicine Physician
  • Edmond, OK
National Provider Identifier
1770998429
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
32698 Issued in OK
Practice address
1208 W 15TH St
Edmond, OK 73013-3001
Phone
(405) 340-2100
Fax
(405) 340-1184
NPI assigned
Jun 20, 2014
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 32698 OK Primary
Family Medicine Physician 207Q00000X R-10027 IA

Addresses

Primary practice location

1208 W 15TH St
Edmond, OK 73013-3001

Mailing address

1208 W 15TH St
Edmond, OK 73013-3001
Phone (405) 340-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20170814000961 OK Practitioner - Family Practice 2860617487 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Oklahoma CommunitiesGroup PAC ID 1153468921, 645 clinicians

Practice addresses (Care Compare)

1208 W 15TH St
Edmond, OK 73013-3001
Phone (405) 340-2100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R-10027IAMDFamily Medicine Physician
32698OKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Logan County Inc CurrentSince Aug 7, 2017 Accepting new patients
Mercy Clinic Oklahoma Communities Family Medicine CurrentSince Aug 7, 2017 Accepting new patients
Mercy Hospital Logan County, Inc CurrentSince Aug 7, 2017 Accepting new patients
Mercy Hospital Oklahoma City, Inc Past Accepting new patients
Summit Medical Center Past Accepting new patients
Mercy Hospital Oklahoma City, Inc Past Accepting new patients

Locations

530 N Monte Vista St
Ste A
Ada, OK 74820
Phone (580) 310-9510

1208 W 15th St
Edmond, OK 73013
Phone (405) 340-2100

200 S Academy Rd
Guthrie, OK 73044
Phone (405) 260-4165

2919 S Division St
Guthrie, OK 73044
Phone (405) 282-6301

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

4505 Memorial Cir
Oklahoma City, OK 73142
Phone (405) 749-7099

8325 NW Expressway
Oklahoma City, OK 73162
Phone (405) 728-8000

Interoperability endpoints

  • Direct secure messaging: jjohnson954040@directc.mercy.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1403222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1770998429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 W 15TH ST",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133001",
            "telephone_number": "405-340-2100",
            "fax_number": "405-340-1184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 W 15TH ST",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133001",
            "telephone_number": "405-340-2100",
            "fax_number": "405-340-1184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JERIMIAH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-20",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "32698",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "R-10027",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

Verify at the official NPI Registry.