Marc Thomas Johannsen (NPI# 1538329644, PAC ID# 3072751403) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DIAGNOSTIC RADIOLOGY.
| Nation Provider ID (NPI) | 1538329644 |
| PAC ID by PECOS | 3072751403 |
| Professional Enrollment ID | I20190116001698 |
| Full Name | Marc Thomas Johannsen |
| Organization Legal Name | DIRECT RADIOLOGY PLLC |
| Address |
2507 Holly Point Rd E Orange Park FL 32073-5632 |
| Phone Number | 9043152004 |
| Gender | M |
| Medical School | PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE |
| Graduation Year | 2008 |
| Primary Specialty | DIAGNOSTIC RADIOLOGY |
| Group Practice PAC ID | 9436396165 |
| Number of Group Practice Members | 59 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 490024 | CARILION MEDICAL CENTER |
| 490042 | CARILION NEW RIVER VALLEY MEDICAL CENTER |
| 490089 | CARILION FRANKLIN MEMORIAL HOSPITAL |
| 491302 | CARILION GILES COMMUNITY HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 2507 Holly Point Rd E, Orange Park, FL 32073-5632 | 9043152004 | DIRECT RADIOLOGY PLLC |
| Organization Legal Name | DIRECT RADIOLOGY PLLC |
| Physicians | 8 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jonathan R Wood | Diagnostic Radiology | Direct Radiology Pllc | 44 -132 Hako St, Apt 2, Kaneohe, HI 96744-2507 |
| James Clark Haug | Diagnostic Radiology | Direct Radiology Pllc | 8611 Lantana Spgs, Converse, TX 78109-2332 |
| Joseph G Mollura | Diagnostic Radiology | Direct Radiology Pllc | 845 United Nations Plz, Apt 47d, New York, NY 10017-3535 |
| Matthew D. Moore | Diagnostic Radiology | Direct Radiology Pllc | 9658 23rd Bay St, Norfolk, VA 23518-1704 |
| Baharak Bagheri | Diagnostic Radiology | Direct Radiology Pllc | 23568 Highland Dr, Fergus Falls, MN 56537-8170 |
| Edmund D Harris | General Practice | Direct Radiology Pllc | 159 Thornton Ln, Lakehills, TX 78063-4314 |
| Karen Dittrich | Diagnostic Radiology | Direct Radiology Pllc | 95 E 4100, Park City, UT 84098-6323 |
| Street Address |
2507 HOLLY POINT RD E |
| City | ORANGE PARK |
| State | FL |
| Zip | 32073-5632 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Rahman Karimi | Internal Medicine | Mcci Group Holdings LLC | 8 Blanding Blvd, Suite 20, Orange Park, FL 32073-2202 |
| Carlos R Villa | Optometry | Myeyedr Optometry of Florida, LLC | 28 Blanding Blvd, Orange Park, FL 32073-2202 |
| Robert Morris | Chiropractic | 1871 Wells Rd, Orange Park, FL 32073-2351 | |
| Ali Tabatabai | Optometry | Family First Vision Care Pllc | 1911 Wells Rd, Suite 6, Orange Park, FL 32073-2372 |
| Darren R Blom | Optometry | Family First Vision Care Pllc | 1911 Wells Rd, Suite 6, Orange Park, FL 32073-2372 |
| Shaila N Williston | Family Practice | 1700 Wells Rd, Suite 27, Orange Park, FL 32073-2374 | |
| Joseph N Salameh | Chiropractic | Jns Physicians Group LLC | 1700 Wells Rd, Orange Park, FL 32073-2374 |
| Marcus Decarvalho | Psychiatry | 1677 Wells Rd, Suite A, Orange Park, FL 32073-2383 | |
| Blake Bazel | Psychologist, Clinical | 1677 Wells Rd, Suite A, Orange Park, FL 32073-2383 | |
| Hewell B Eaves | Optometry | Mack Eye Care Pa | 88 Blanding Blvd, Orange Park, FL 32073-2601 |
| Find all physicians in zip 32073 | |||
| City | ORANGE PARK |
| Zip Code | 32073 |
| Specialty | DIAGNOSTIC RADIOLOGY |
| City + Specialty | ORANGE PARK + DIAGNOSTIC RADIOLOGY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.