Individual provider Active NPI

Jessica Richason Johnson, MHA, DPM

  • Podiatrist
  • Richmond, VA
National Provider Identifier
1922416056
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
0116027528 Issued in VA
Practice address
1201 Broad Rock Blvd
Richmond, VA 23224-4915
Phone
(804) 675-4765
NPI assigned
Aug 1, 2014
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 0116027528 VA Primary

Addresses

Primary practice location

1201 Broad Rock Blvd
Richmond, VA 23224-4915

Mailing address

1201 Broad Rock Blvd
Richmond, VA 23224-4915
Phone (804) 675-4765

Other identifiers 1

IdentifierTypeStateIssuer
1922416056MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170807000498 CO Practitioner - Podiatry 4587935747 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Preferred Podiatry Group PCGroup PAC ID 3971412677, 131 clinicians

Practice addresses (Care Compare)

221 2ND St
Fowler, CO 81039-1201
Phone (719) 263-4234

Merit-based Incentive Payment System (MIPS)

Final score
87.82 of 100Reported as group
Quality
72.99
Improvement activities
40
Cost
75.6

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue59
Removal or shaving of skin growth27

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0116027528VAMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
David Erik Ouderkirk DPM PC Podiatrist CurrentSince Jun 29, 2020 Accepting new patients
David Erik Ouderkirk DPM PC Podiatrist CurrentSince Jun 29, 2020 Accepting new patients
Preferred Podiatry Group PC Podiatrist CurrentSince Jul 24, 2017 Accepting new patients

Locations

3464 S Willow St
Ste 138
Denver, CO 80231

221 2nd St
Fowler, CO 81039
Phone (719) 263-4234

1330 Sidney Ave
Sterling, CO 80751
Phone (970) 522-4888

425 Huehl Rd
#13
Northbrook, IL 60062
Phone (847) 504-5007

Organizations & group practices 3

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": "1406851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1922416056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 BROAD ROCK BLVD",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232244915",
            "telephone_number": "804-675-4765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 BROAD ROCK BLVD",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232244915",
            "telephone_number": "804-675-4765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JESSICA",
        "middle_name": "RICHASON",
        "name_prefix": "Dr.",
        "credential": "MHA, DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-01",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "VA",
            "license": "0116027528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922416056",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.