Johanna S. Fricke, M.D., LLC

Primary specialty

Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X

Legal business name

JOHANNA S. FRICKE, M.D., LLC

Practice address

311 N Buffalo Dr
Suite B
Las Vegas, NV 89145-0375

Phone

(702) 877-2520

Fax

(702) 877-2521

NPI assigned

Feb 3, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Johanna Fricke, M.D.NPI 1801874631

Title

Physician/Ceo

Phone

(702) 804-9065

Specialties & licenses 4

Addresses

Other identifiers 4

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Johanna S. Fricke, M.D.

  • Developmental - Behavioral Pediatrics Physician
  • Las Vegas, NV
  • NPI 1801874631
  NPD (past) Authorized official

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

{
    "created_epoch": "1391385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1790108264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 PREMIER CT",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891177134",
            "telephone_number": "702-804-9065",
            "fax_number": "702-877-2521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 N BUFFALO DR",
            "address_2": "SUITE B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891450375",
            "telephone_number": "702-877-2520",
            "fax_number": "702-877-2521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHANNA S. FRICKE, M.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-03",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "FRICKE",
        "authorized_official_first_name": "JOHANNA",
        "authorized_official_title_or_position": "PHYSICIAN/CEO",
        "authorized_official_telephone_number": "702-804-9065",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "NV",
            "license": null,
            "primary": true
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NV",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NV",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NV",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIFIED/MEDICARE",
            "identifier": "32876",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002002223",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PHARMACY",
            "identifier": "CS09750",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIFIED/NV MEDICAID",
            "identifier": "003102223",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara H Joeckel, M.D.
• Joel N. Lubritz MD Chartered
• Kim Joffe
• Michel Matthew Joffe, MD
• Johana M Landahl PLLC
• Faith Johannes, MSW
• Kenneth Johansson
• John a Ellerton MD.LTD Dba Cancer Consultants
• John C Griffiths DDS MDS a Professional Corporation
• John D. Utley, D.P.M. Professional Corporation

• Developmental - Behavioral Pediatrics Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Developmental - Behavioral Pediatrics Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.