NPIMap

Individual provider Active NPI

Walter G Johnson, MD

  • Cardiovascular Disease Physician
  • Merritt Island, FL
National Provider Identifier
1871503607
Registry record updated Sep 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
ME56254 Issued in FL
Practice address
150 N Sykes Creek Pkwy
# 300
Merritt Island, FL 32953-3488
Phone
(321) 452-3811
Fax
(321) 454-4026
NPI assigned
Aug 8, 2006
Last updated
Sep 6, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X ME56254 FL Primary
Interventional Cardiology Physician 207RI0011X ME56254 FL
Internal Medicine Physician 207R00000X ME56254 FL

Addresses

Primary practice location

150 N Sykes Creek Pkwy
# 300
Merritt Island, FL 32953-3488

Mailing address

PO Box 11406
Belfast, ME 04915-4005
Phone (321) 452-3811

Other identifiers 1

IdentifierTypeStateIssuer
069823700MedicaidFL

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 Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
PRN Home Care, Inc. Cardiovascular Disease Current Accepting new patients
Brevard Cardiology Physicians PA Cardiovascular Disease Past Accepting new patients
Stewart and Stewart a Medical Corporation Internal Medicine Past Accepting new patients
Wuesthoff Brevard Cardiology Group Cardiovascular Disease Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473120000000",
    "number": "1871503607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11406",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154005",
            "telephone_number": "321-452-3811",
            "fax_number": "321-454-4026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 N SYKES CREEK PKWY",
            "address_2": "# 300",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329533488",
            "telephone_number": "321-452-3811",
            "fax_number": "321-454-4026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "WALTER",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2016-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME56254",
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "FL",
            "license": "ME56254",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME56254",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "069823700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merritt Island, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.