Active NPI
Charles William Johnson, D.O.
- Family Medicine Physician
- Lees Summit, MO
National Provider Identifier
1932444924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 33630
- Practice address
- 106 NE Wood Glen LN
Lees Summit, MO 64064-1508 - Phone
- (816) 373-2734
- NPI assigned
- Dec 3, 2012
- Sex
- Male
- 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 | 33630 | MO | Primary |
Addresses
Primary practice location
106 NE Wood Glen LN
Lees Summit, MO 64064-1508
Mailing address
106 NE Wood Glen LN
Lees Summit, MO 64064-1508
Phone (816) 373-2734
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)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33630 | MO | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354492800000",
"number": "1932444924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 NE WOOD GLEN LN",
"city": "LEES SUMMIT",
"state": "MO",
"postal_code": "640641508",
"telephone_number": "816-373-2734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 NE WOOD GLEN LN",
"city": "LEES SUMMIT",
"state": "MO",
"postal_code": "640641508",
"telephone_number": "816-373-2734"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "CHARLES",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-12-03",
"last_updated": "2012-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "33630",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lees Summit, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.