Individual provider Active NPI

Derek B Johnson, M.D.

  • Surgery Physician
  • Santa Fe, NM
National Provider Identifier
1912944661
Registry record updated Aug 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD2018-0748 Issued in NM
Practice address
454 Saint Michaels Dr Ste 200
Santa Fe, NM 87505
Phone
(505) 303-5000
NPI assigned
Jun 1, 2006
Last updated
Aug 28, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 224930 MA
Surgery Physician 208600000X 49065 WI
Surgery Physician 208600000X MD2018-0748 NM Primary

Addresses

Primary practice location

454 Saint Michaels Dr Ste 200
Santa Fe, NM 87505

Mailing address

PO Box 26666
PHS Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-6770

Other practice location 1

100 County Road B
Shawano, WI 54166-7072
Phone (715) 524-2161

Other identifiers 2

IdentifierTypeStateIssuer
34863900MedicaidWI
057945003OtherWIMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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

Enrollment IDStateProvider typePAC IDDetails
I20180912002295 NM Practitioner - General Surgery 0143225276 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
88.68 of 100Reported as group
Quality
82.35
Promoting interoperability
100
Improvement activities
40
Cost
76.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
224930MAMDSurgery Physician
MD2018-0748NMMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Roswell Clinic Corp CurrentSince Jan 1, 2023 Accepting new patients
Roswell Clinic Corp Surgery CurrentSince Jan 1, 2023 Accepting new patients
Presbyterian Healthcare Services Surgery CurrentSince Sep 4, 2018 Accepting new patients
Presbyterian Healthcare Services CurrentSince Sep 4, 2018 Accepting new patients
Surgical Associates Sauk-Prairie, LLP Surgery Past Accepting new patients
Presbyterian Healthcare Services Past Accepting new patients

Locations

201 Cedar St SE
Ste 306
Albuquerque, NM 87106
Phone (505) 247-3635

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

601 W Country Club Rd
Ste 101
Roswell, NM 88201
Phone (575) 622-8170

454 Saint Michaels Dr
Ste 200
Santa Fe, NM 87505
Phone (505) 303-5000

454 Saint Michaels Dr
Santa Fe, NM 87505
Phone (505) 303-5000

Interoperability endpoints

  • Direct secure messaging: djohnson123824@direct.phs.org

Organizations & group practices 6

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": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535414400000",
    "number": "1912944661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26666",
            "address_2": "PHS PROVIDER ENROLLMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256666",
            "telephone_number": "505-923-6770",
            "fax_number": "505-923-5354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 SAINT MICHAELS DR STE 200",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "87505",
            "telephone_number": "505-303-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 County Road B",
            "address_purpose": "LOCATION",
            "city": "Shawano",
            "state": "WI",
            "postal_code": "541667072",
            "country_code": "US",
            "telephone_number": "715-524-2161",
            "fax_number": "715-524-8164",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DEREK",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2018-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "224930",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "49065",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NM",
            "license": "MD2018-0748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34863900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "057945003",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Fe, NM

Sources for this page

Verify at the official NPI Registry.