NPIMap

Individual provider Active NPI

Douglas Mark Johnson, DO

  • Diagnostic Radiology Physician
  • Winston Salem, NC
National Provider Identifier
1811974553
Registry record updated Sep 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2005-01288 Issued in NC
Practice address
Medical Center Blvd
Winston Salem, NC 27157-0001
Phone
(336) 716-2255
NPI assigned
Dec 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2010

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X 200501288 NC
Diagnostic Radiology Physician 2085R0202X 200501288 NC
Diagnostic Radiology Physician 2085R0202X 2005-01288 NC Primary

Addresses

Primary practice location

Medical Center Blvd
Winston Salem, NC 27157-0001

Mailing address

620 Summit Crossing Place
Suite 106
Gastonia, NC 28054-2189
Phone (704) 867-8021

Other identifiers 1

IdentifierTypeStateIssuer
5902558MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060109000564 NC Practitioner - Diagnostic Radiology 8921037185 Reassigns benefits to 1 organization
I20200115001070 SC Practitioner - Diagnostic Radiology 8921037185 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Arizona College of Osteopathic Medicine Mid Western University, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

171 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-1414

3000 Saint Matthews Rd
Orangeburg, SC 29118-1442
Phone (803) 395-3400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.22 of 100Reported as group
Quality
95.56
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
80.41 of 100Reported as group
Quality
64.93
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200501288NCMDBody Imaging Physician
2005-01288NCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Community Physicians CurrentSince Jan 3, 2024 Accepting new patients
University Medical Associates of the Medical University of South Carol Current Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Jul 1, 2024 Accepting new patients
Tidelands Health Market Common LLC CurrentSince Jan 1, 2026 Accepting new patients
University Medical Associates of the Medical University of South Carol Diagnostic Radiology CurrentSince Jul 1, 2024 Accepting new patients
Medical University Hospital Authority Imaging Center Body Imaging CurrentSince Jun 7, 2024 Accepting new patients
Musc Community Physicians CurrentSince Jan 3, 2024 Accepting new patients
Musc Community Physicians Diagnostic Radiology Current Accepting new patients
Tidelands and Medquest Joint Venture, LLC CurrentSince Jan 1, 2026 Accepting new patients
Mercy Hospital Grayling Past Accepting new patients
Mercy Professional Services Diagnostic Radiology Past Accepting new patients
Wake Forest University Health Sciences Past Accepting new patients

Locations

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

3000 Saint Matthews Rd
Orangeburg, SC 29118
Phone (803) 395-2200

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 12

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": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285113600000",
    "number": "1811974553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 SUMMIT CROSSING PLACE",
            "address_2": "SUITE 106",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542189",
            "telephone_number": "704-867-8021",
            "fax_number": "704-864-4606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DOUGLAS",
        "middle_name": "MARK",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-23",
        "last_updated": "2010-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "NC",
            "license": "200501288",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "200501288",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2005-01288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902558",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.