IAN JAMES JOHNSON M.D.
Complete NPI Record 1265404990
Pediatrics - Adolescent Medicine in Patrick Afb, FL
NPI Status: Active since February 06, 2006
Contact Information
1381 SOUTH PATRICK DR, PATRICK AFB
45 MEDICAL GROUP
PATRICK AFB, FL
ZIP 32925
Phone: (321) 494-8152
Fax: (321) 494-8533
Complete NPI Dataset
This directory record outlines the complete schema field listings, logged data values, and structural definitions for IAN JAMES JOHNSON M.D. (NPI: 1265404990), practicing as a certified pediatrics specialist with primary operations located in Patrick Afb, FL. The dataset listed below details the current information logged inside the National Plan and Provider Enumeration System (NPPES) registry database for this specific individual assignment. Please use the integrated filtering tools directly below to separate properties by functional clinical categories, perform live keyword lookups, or jump immediately to a single tracking attribute line item.
Registry File Document Utilities
- NPI: 1265404990
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 1
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Provider Last Name Legal Name: JOHNSON
- The last name of the provider. If the provider is an individual, this is the legal name.
- Provider First Name: IAN
- The first name of the provider, if the provider is an individual.
- Provider Middle Name: JAMES
- The middle name of the provider, if the provider is an individual.
- Provider Credential Text: M.D.
- The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
- Provider First Line Business Mailing Address: 4066 HIELD RD NW
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: PALM BAY
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: FL
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 329076307
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 3216740932
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 3216746200
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 1381 SOUTH PATRICK DR, PATRICK AFB
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Second Line Business Practice Location Address: 45 MEDICAL GROUP
- The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: PATRICK AFB
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: FL
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 329254162
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 3214948152
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 3214948533
- The fax number associated with the location address of the provider being identified.
- Provider Gender Code: M
- The code designating the provider's gender if the provider is a person.
- Healthcare Provider Taxonomy Code 1: 2080A0000X
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 1: G0440
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 1: TX
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 1: Y
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Sole Proprietor: N
- Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
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