Individual provider Active NPI

Mary Johnson, NP

  • Adult Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1841861168
Registry record updated Mar 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
310464 Issued in NY
Practice address
228 Park Ave S Ste 16389
New York, NY 10003-0103
Phone
(646) 876-8455
NPI assigned
Jul 7, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2026

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 310464 NY Primary
Adult Health Nurse Practitioner 363LA2200X NP500225972 DC
Adult Health Nurse Practitioner 363LA2200X 4704439802 MI
Adult Health Nurse Practitioner 363LA2200X 0024194096 VA
Adult Health Nurse Practitioner 363LA2200X RN10028361 MA
Adult Health Nurse Practitioner 363LA2200X R275385 MD
Adult Health Nurse Practitioner 363LA2200X TPAN35453 FL

Addresses

Primary practice location

228 Park Ave S Ste 16389
New York, NY 10003-0103

Mailing address

169 Madison Ave Ste 381114
New York, NY 10016-5101
Phone (646) 876-8455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211027002636 NY Practitioner - Nurse Practitioner 1052709839 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.62 of 100Reported as apm
Quality
74.51
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP500225972DCMDAdult Health Nurse Practitioner
TPAN35453FLMDAdult Health Nurse Practitioner
RN10028361MAMDAdult Health Nurse Practitioner
R275385MDMDAdult Health Nurse Practitioner
4704439802MIMDAdult Health Nurse Practitioner
310464NYMDAdult Health Nurse Practitioner
0024194096VAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rochester General Hospital CurrentSince Nov 8, 2021 Accepting new patients
The Unity Hospital of Rochester CurrentSince Nov 8, 2021 Accepting new patients
Rochester General Hospital CurrentSince Nov 8, 2021 Accepting new patients
Clifton Springs Sanitarium Co CurrentSince Nov 8, 2021 Accepting new patients
Western New York Medical Practice PC CurrentSince Nov 8, 2021 Accepting new patients
Western New York Medical Practice P.C. CurrentSince Nov 8, 2021 Accepting new patients
The Unity Hospital of Rochester Current Accepting new patients

Locations

2 Coulter Rd
Clifton Springs, NY 14432
Phone (315) 462-1472

224 Alexander St
Rochester, NY 14607
Phone (585) 922-7770

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

Interoperability endpoints

  • Direct secure messaging: mary.johnson.1@22307.direct.athenahealth.com

Organizations & group practices 7

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": "1625616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773792000000",
    "number": "1841861168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 MADISON AVE STE 381114",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100165101",
            "telephone_number": "646-876-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 PARK AVE S STE 16389",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100030103",
            "telephone_number": "646-876-8455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-07",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "310464",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "DC",
            "license": "NP500225972",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704439802",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "VA",
            "license": "0024194096",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "RN10028361",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MD",
            "license": "R275385",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "TPAN35453",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.