Active NPI
Clarissa Johnston, DO
- Family Medicine Physician
- Phoenix, AZ
National Provider Identifier
1851371579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2310
- Practice address
- 11416 N 44TH CT
Phoenix, AZ 85028-2325 - Phone
- (480) 242-7400
- NPI assigned
- Jan 19, 2006
- Last updated
- Dec 15, 2011
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2310 | AZ | Primary |
Addresses
Primary practice location
11416 N 44TH CT
Phoenix, AZ 85028-2325
Mailing address
11416 N. 44TH Court
Phoenix, AZ 85028-2325
Phone (480) 242-7400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 270223 | 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)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2310 | AZ | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jojor Enterprises Inc. | Past | Accepting new patients | |
| Center for Physical Medicine & Rehabilitation P C | Past | Accepting new patients | |
| Med 97 LLC | Past | Accepting new patients | |
| Banner Urgent Care - Surprise | Past | Accepting new patients | |
| Banner Sun City Medical Group | Past | Accepting new patients |
Organizations & group practices 5
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 Synergy Home Care
- In Home Supportive Care Agency
- Sun City, AZ
- NPI 1265671622
-
- Multi-Specialty Clinic/Center
- Sun City, AZ
- NPI 1902067200
-
- Urgent Care Clinic/Center
- Surprise, AZ
- NPI 1649406273
-
- Physical Medicine & Rehabilitation Physician
- Phoenix, AZ
- NPI 1306959218
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323907200000",
"number": "1851371579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11416 N. 44TH COURT",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850282325",
"telephone_number": "480-242-7400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11416 N 44TH CT",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850282325",
"telephone_number": "480-242-7400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSTON",
"first_name": "CLARISSA",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-19",
"last_updated": "2011-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "2310",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "270223",
"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 Dec 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.