Active NPI
Alexandra Rothenberg Johnson, MD
- Family Medicine Physician
- Santa Cruz, CA
National Provider Identifier
1932425956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- A148633
- Practice address
- 1690 Glen Canyon Rd
Santa Cruz, CA 95060-1219 - Phone
- (510) 455-8008
- Fax
- (510) 244-0569
- NPI assigned
- Apr 15, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A148633 | CA | Primary |
Addresses
Primary practice location
1690 Glen Canyon Rd
Santa Cruz, CA 95060-1219
Mailing address
1690 Glen Canyon Rd
Santa Cruz, CA 95060-1219
Phone (510) 455-8008
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 316228YL0X | Other | CO | MEDICARE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 19, 2024 through Feb 19, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A148633 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703635200000",
"number": "1932425956",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1690 GLEN CANYON RD",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950601219",
"telephone_number": "510-455-8008",
"fax_number": "510-244-0569"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1690 GLEN CANYON RD",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950601219",
"telephone_number": "510-455-8008",
"fax_number": "510-244-0569"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "ALEXANDRA",
"middle_name": "ROTHENBERG",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-04-15",
"last_updated": "2023-12-27",
"certification_date": "2023-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A148633",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE NUMBER",
"identifier": "316228YL0X",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Cruz, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.