DR. MARY BETH JOHNSON DDS
NPI 1437292570
Dentist - General Practice in Polacca, AZ
About Dr. Mary Beth Johnson Dds NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. MARY BETH JOHNSON DDS (NPI 1437292570) is an individual general practice provider in Polacca, Arizona, licensed in Ohio (30020478) and active in the NPI registry since February 2007. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Mary Beth Johnson Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Mary Johnson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Kykotsmovi, AZ 86039
- Reassigned Medicare billing, Texas enrollment
- 540 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 86042 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 6
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
POLACCA, AZ 86042
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Mary Johnson's NPI number?
The NPI number for Mary Johnson is 1437292570. It was assigned to this individual provider in the NPPES registry on February 15, 2007.
Where is Mary Johnson located?
Mary Johnson practices at Hwy 264, Mp 388, Polacca, AZ 86042. The listed phone number is (928) 737-6162.
What is Mary Johnson's specialty?
The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.
Is Mary Johnson enrolled in Medicare?
Yes. Mary Johnson is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Mary Johnson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mary Johnson reassigns Medicare benefits to Tuba City Regional Health Care Corporation (Kykotsmovi, AZ). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mary Johnson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Mary Johnson was last updated on June 26, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dr. Mary Beth Johnson, DDS · NPI 1437292570
General Practice provider in Polacca, Arizona. Individual provider, active in the CMS NPPES registry since February 15, 2007.
## Identity
- **NPI:** 1437292570 (Entity type: Individual)
- **Enumerated:** February 15, 2007
- **Primary specialty:** Dentist - General Practice · taxonomy 1223G0001X
- **State license:** 30020478 (Ohio)
- **Sole proprietor:** No
## Practice location
- **Address:** HWY 264, MP 388, Polacca, AZ 86042
- **Phone:** (928) 737-6162
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** Tuba City Regional Health Care Corporation (NPI 1396921870, Kykotsmovi, AZ), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 26, 2009
- **Other identifiers:** Medicaid 420456 (AZ)
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Source: [NPI Profile](https://npiprofile.com/npi/1437292570) · Data from the CMS NPPES public registry.