Active NPI
Mary Johnston
- Family Medicine Physician
- Albany, NY
National Provider Identifier
1922182856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 167722
- Practice address
- 391 Myrtle Avenue
Suite 4a
Albany, NY 12208 - Phone
- (518) 207-2273
- Fax
- (518) 207-2293
- NPI assigned
- Oct 25, 2006
- Last updated
- Dec 11, 2015
- 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 | 167722 | NY | Primary |
Addresses
Primary practice location
391 Myrtle Avenue
Suite 4a
Albany, NY 12208
Mailing address
711 Troy Schenectady Rd
Suite 203
Latham, NY 12110-2442
Phone (518) 782-3700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01054966 | Medicaid | NY |
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
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Care Physicians, PC | Past | Accepting new patients |
Organizations & group practices 1
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 Community Care Lab Care
- Internal Medicine Physician
- Latham, NY
- NPI 1023380714
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449792000000",
"number": "1922182856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 TROY SCHENECTADY RD",
"address_2": "SUITE 203",
"city": "LATHAM",
"state": "NY",
"postal_code": "121102442",
"telephone_number": "518-782-3700",
"fax_number": "518-782-3799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "391 MYRTLE AVENUE",
"address_2": "SUITE 4A",
"city": "ALBANY",
"state": "NY",
"postal_code": "12208",
"telephone_number": "518-207-2273",
"fax_number": "518-207-2293"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSTON",
"first_name": "MARY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-25",
"last_updated": "2015-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "167722",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01054966",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albany, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.