Active NPI
Gregory Justin Johnson
- Dentist
- Richardton, ND
National Provider Identifier
1881677094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1720
- Practice address
- 200 3Rd Ave W
Richardton, ND 58652-0333 - Phone
- (701) 974-2118
- Fax
- (701) 974-2175
- NPI assigned
- Nov 22, 2005
- Last updated
- May 4, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 1720 | ND | Primary |
Addresses
Primary practice location
200 3Rd Ave W
Richardton, ND 58652-0333
Mailing address
200 3Rd Ave W
Richardton, ND 58652-0333
Phone (701) 974-2118
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40988 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151123000717 | ND | Order and Referring Only - Dentist | 4183924228 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1720 | ND | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493856000000",
"number": "1881677094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 3RD AVE W",
"city": "RICHARDTON",
"state": "ND",
"postal_code": "586520333",
"telephone_number": "701-974-2118",
"fax_number": "701-974-2175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 3RD AVE W",
"city": "RICHARDTON",
"state": "ND",
"postal_code": "586520333",
"telephone_number": "701-974-2118",
"fax_number": "701-974-2175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "GREGORY",
"middle_name": "JUSTIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-22",
"last_updated": "2017-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ND",
"license": "1720",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40988",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richardton, ND
- Hoff Chiropractic
- Lee A Hoff, D.C.
- Karen Horack
- Megan Hueske, OD
- Jacobson Memorial Hospital Care Center (Richardton Clinic)
- Renae Marie Kobriger
- Richardton Health Center, Inc. (Richardton Memorial Hospital and Health Center)
- Richardton Rural Fire Protection District
- Richardton Taylor Rural Ambulance District
- S & V Inc (Country Drugstore)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2017; 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.