Individual provider Active NPI

James Gilliam Johnston II, MD

  • Family Medicine Physician
  • Lebanon, NH
National Provider Identifier
1811963283
Registry record updated Dec 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
14733 Issued in NH
Practice address
18 Old Etna Rd
DHMC - Family Medicine
Lebanon, NH 03766
Phone
(603) 650-4000
Fax
(603) 650-4198
NPI assigned
Feb 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 14733 NH Primary
Family Medicine Physician 207Q00000X 042-0011922 VT
Family Medicine Physician 207Q00000X 012982 ME

Addresses

Primary practice location

18 Old Etna Rd
DHMC - Family Medicine
Lebanon, NH 03766

Mailing address

1 Medical Center Dr
DHMC Family Medicine
Lebanon, NH 03756-1000
Phone (603) 650-4000

Other identifiers 3

IdentifierTypeStateIssuer
1017549MedicaidVT
315300099MedicaidME
30209510MedicaidNH

Other names 1

  • J. Gilliam Johnston Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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

Enrollment IDStateProvider typePAC IDDetails
I20100627000022 NH Practitioner - Family Practice 9638114119 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
012982MEMDFamily Medicine Physician
14733NHMDFamily Medicine Physician
042-0011922VTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Hitchcock Memorial Hospital CurrentSince Apr 20, 2010 Accepting new patients
Dartmouth-Hitchcock Clinic CurrentSince Apr 20, 2010 Accepting new patients
Mary Hitchcock Memorial Hospital CurrentSince Apr 20, 2010 Accepting new patients

Locations

1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922

18 Old Etna Rd
Lebanon, NH 03766
Phone (603) 650-3100

1290 Hospital Dr
Ste 3
St Johnsbury, VT 05819
Phone (802) 473-4100

289 County Rd
Windsor, VT 05089
Phone (802) 674-7220

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354665600000",
    "number": "1811963283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "address_2": "DHMC FAMILY MEDICINE",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037561000",
            "telephone_number": "603-650-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 OLD ETNA RD",
            "address_2": "DHMC - FAMILY MEDICINE",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "03766",
            "telephone_number": "603-650-4000",
            "fax_number": "603-650-4198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "JAMES",
        "middle_name": "GILLIAM",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-27",
        "last_updated": "2012-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NH",
            "license": "14733",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VT",
            "license": "042-0011922",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "012982",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1017549",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "315300099",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30209510",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "J.",
            "last_name": "JOHNSTON",
            "middle_name": "GILLIAM",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Lebanon, NH

Sources for this page

Verify at the official NPI Registry.