Active NPI
Derek B Johnson, M.D.
- Surgery Physician
- Santa Fe, NM
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD2018-0748
- 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, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34863900 | Medicaid | WI | |
| 057945003 | Other | WI | MEDICARE 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
Enrollment records 1
Care Compare profile
Medicare Care CompareMerit-based Incentive Payment System (MIPS)
- Final score
- 88.68 of 100
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| 224930 | MA | MD | Surgery Physician |
| MD2018-0748 | NM | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roswell Clinic Corp | Current | Accepting new patients | |
| Roswell Clinic Corp | Surgery | Current | Accepting new patients |
| Presbyterian Healthcare Services | Surgery | Current | Accepting new patients |
| Presbyterian Healthcare Services | Current | 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
- 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.
-
dba Presbyterian Medical Group
- Internal Medicine Physician
- Albuquerque, NM
- NPI 1104802354
Surgery
-
dba Presbyterian Hospital
- General Acute Care Hospital
- Albuquerque, NM
- NPI 1215913470
-
dba Eastern Plains Urology
- Durable Medical Equipment & Medical Supplies
- Roswell, NM
- NPI 1396958633
-
dba Espanola Hospital
- Rural Acute Care Hospital
- Espanola, NM
- NPI 1154307593
-
- Surgery Physician
- Prairie Du Sac, WI
- NPI 1699785816
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2018; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.