Derick Michael Johnson, D.O.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

L1206639 Issued in MI

Practice address

3299 N Wellness Dr
BLDG C, #150
Holland, MI 49424-7269

Phone

(616) 738-3884

Fax

(616) 738-4432

NPI assigned

Jul 25, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Orthopedic Surgery

Education

Other, 2004

Medicare assignment

May accept Medicare assignment

Group practices

Holland Community HospitalGroup PAC ID 0446157291, 174 clinicians

Center for Physical Rehabilitation IncGroup PAC ID 6901717768, 352 clinicians

Center for Physical Rehabilitation and Therapy LPGroup PAC ID 0941513303, 365 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Holland Hospital Hospital, Holland, MI, CCN 230072
• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
• Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021

Merit-based Incentive Payment System (MIPS)

Final score

84.02 of 100Reported as individual

Quality

80.23

Improvement activities

40

Cost

82.96

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: derick.johnson@holland.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Holland Community Hospital

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Holland, MI
  • NPI 1780888099
  Medicare reassignment Care Compare group NPD
• Center for Physical Rehabilitation and Therapy LP

  • Physical Therapy Clinic/Center
  • Grand Rapids, MI
  • NPI 1902288863
  Care Compare group
• Holland Community Hospital

  • Family Medicine Physician
  • Hudsonville, MI
  • NPI 1952130585
  NPD
• Holland Community Hospital

  • Otolaryngology Physician
  • Holland, MI
  • NPI 1982910857
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Holland Community Hospital

  • General Acute Care Hospital
  • Holland, MI
  • NPI 1871672618
  Care Compare affiliation
• Lakeland Hospitals at Niles and St Joseph, Inc

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Care Compare affiliation
• Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Spectrum Health Hospitals

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation

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

{
    "created_epoch": "1216944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406073600000",
    "number": "1972768232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3299 N WELLNESS DR",
            "address_2": "BLDG C, #150",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494247269",
            "telephone_number": "616-738-3884",
            "fax_number": "616-738-4432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3299 N WELLNESS DR",
            "address_2": "BLDG C, #150",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494247269",
            "telephone_number": "616-738-3884",
            "fax_number": "616-738-4432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DERICK",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-25",
        "last_updated": "2014-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "58.001489",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "VA",
            "license": "0102202412",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "L1206639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "0102202412",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Johncox
• David Johns, MD
• Tyler Jennings Johns
• Charlotte Johnson, MD
• Denise Marie Johnson, RPH
• Emily Faith Johnson
• Jason Johnson
• Randall Lee Johnson, MA, LLP
• Steven T Johnson, PH.D.
• William A Johnson, PT

• Orthopaedic Surgery Physician in Holland, MI
• Providers in Holland, MI by specialty
• Orthopaedic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.