Ingrid Denise Johnson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0101058986 Issued in VA

Practice address

8640 Sudley Rd
Suite 306
Manassas, VA 20110-4420

Phone

(703) 330-3939

Fax

(703) 331-0959

NPI assigned

Jul 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Pediatricare of Northern Virginia, P.C.

  • Pediatrics Physician
  • Manassas, VA
  • NPI 1104994623
  Medicare reassignment NPD

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1851311898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8640 SUDLEY RD STE 306",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104404",
            "telephone_number": "703-330-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8640 SUDLEY RD",
            "address_2": "SUITE 306",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104420",
            "telephone_number": "703-330-3939",
            "fax_number": "703-331-0959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "INGRID",
        "middle_name": "DENISE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101058986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6704433",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Briana Joceleen Johnson
• Carissa Johnson
• Cynthia J Johnson, PT
• David Lee Johnson
• Gregory Luke Johnson, O.D.
• Juliann Amy Johnson
• Karie Lyn Johnson, LCSW
• Kimberly F Johnson, MS, CCC-SLP
• Marquitta Johnson
• Maryann Johnson, N.P.

• Pediatrics Physician in Manassas, VA
• Providers in Manassas, VA by specialty
• Pediatrics Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.