Physician Compare National (NPI:1336328624)

HEALTHCARE PROVIDER: JUSTIN THEO JOHNSON D.P.M.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1336328624
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7517031057
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080801000224
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JOHNSON
	Individual professional last name
Provider First Name	JUSTIN
	Individual professional first name
Provider Middle Name	T
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2005
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1661 HWY 99 N
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 201
	Group Practice or individual's line 2 address
City	ASHLAND
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	975208900
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	380005
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ASANTE ASHLAND COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y