Individual provider Active NPI

Leroy Johnson, M.D.

  • Ophthalmology Physician
  • Flint, MI
National Provider Identifier
1972880268
Registry record updated Jan 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
4301033852 Issued in MI
Practice address
2900 N Saginaw St
Flint, MI 48505-4452
Phone
(810) 789-9141
Fax
(810) 789-9222
NPI assigned
Nov 15, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 4301033852 MI Primary

Addresses

Primary practice location

2900 N Saginaw St
Flint, MI 48505-4452

Mailing address

225 E 5TH St
Suite 300
Flint, MI 48502-1641
Phone (810) 406-4246

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120322000498 MI Practitioner - Ophthalmology 0345400792 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301033852MIMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hamilton Community Health Network Inc. CurrentSince Mar 14, 2017 Accepting new patients
Hamilton Community Health Network, Inc. CurrentSince Mar 14, 2017 Accepting new patients

Locations

225 E 5th St
Ste 300
Flint, MI 48502
Phone (810) 406-4912

2900 N Saginaw St
Flint, MI 48505
Phone (810) 789-9141

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1321315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610064000000",
    "number": "1972880268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 E 5TH ST",
            "address_2": "SUITE 300",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485021641",
            "telephone_number": "810-406-4246",
            "fax_number": "810-424-6029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 N SAGINAW ST",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485054452",
            "telephone_number": "810-789-9141",
            "fax_number": "810-789-9222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "LEROY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-15",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301033852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, MI

Sources for this page

Verify at the official NPI Registry.