Active NPI
Sue B Johnson, MD
- Pediatrics Physician
- Phoenix, AZ
National Provider Identifier
1841270618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 24044
- Practice address
- 12635 N 42ND St
Phoenix, AZ 85032-7601 - Phone
- (602) 494-5500
- NPI assigned
- Jan 18, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 24044 | AZ | Primary |
Addresses
Primary practice location
12635 N 42ND St
Phoenix, AZ 85032-7601
Mailing address
12635 N 42ND St
Phoenix, AZ 85032-7601
Phone (602) 494-5500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 351693 | Medicaid | AZ |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24044 | AZ | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cigna Healthcare of Arizona, Inc. | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba EVERNORTH Care Group
- Multi-Specialty Clinic/Center
- Scottsdale, AZ
- NPI 1073626404
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1841270618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12635 N 42ND ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850327601",
"telephone_number": "602-494-5500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12635 N 42ND ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850327601",
"telephone_number": "602-494-5500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "SUE",
"middle_name": "B",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AZ",
"license": "24044",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "351693",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.