Active NPI
Michael W Johnell, MD
- Surgery Physician
- Greeley, CO
National Provider Identifier
1790700029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 39436
- Practice address
- 1801 16TH St
Greeley, CO 80631-5154 - Phone
- (970) 378-4433
- NPI assigned
- Jul 13, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 39436 | CO | Primary |
Addresses
Primary practice location
1801 16TH St
Greeley, CO 80631-5154
Mailing address
1441 N 12TH St
Phoenix, AZ 85006-2837
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 77174879 | Medicaid | CO |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Banner Greeley Specialists | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Multi-Specialty Clinic/Center
- Greeley, CO
- NPI 1558595611
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259884800000",
"number": "1790700029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1441 N 12TH ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850062837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 16TH ST",
"city": "GREELEY",
"state": "CO",
"postal_code": "806315154",
"telephone_number": "970-378-4433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNELL",
"first_name": "MICHAEL",
"middle_name": "W",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-13",
"last_updated": "2009-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CO",
"license": "39436",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "77174879",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greeley, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.