Jacob Daniel Johnson, DO

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

5101020933 Issued in MI

Practice address

15411 Park Village Blvd
Taylor, MI 48180-4886

Phone

(646) 714-1984

NPI assigned

Apr 25, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Interoperability endpoints

• Direct secure messaging: jjohnson403674@ecommunitydirect.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448064000000",
    "number": "1962760124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15411 PARK VILLAGE BLVD",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481804886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15411 PARK VILLAGE BLVD",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481804886",
            "telephone_number": "646-714-1984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACOB",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-25",
        "last_updated": "2015-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "5101020933",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "5101020933",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Marie Johns
• Bettie Johnson
• Dawana Johnson
• Donna M Johnson, MSW
• Douglas Scott Johnson, ATC
• Jimmie Lee Johnson Sr., COUNSELOR
• Shon Johnson, DDS
• Angela Joiner
• Robin Jones, MS, LLP
• Joon Y. Choi M.D. P.C.

• All providers in Taylor, MI
• Vascular Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.

Verify at the official NPI Registry.