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Deactivated NPI 1114018900 Deactivated / Inactive NPI Male Practitioner

Dr. Derrick Anthony Johnson , MD

General Practice • Playa Del Rey, CA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Derrick Johnson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 27, 2006
NPI Deactivation Date June 19, 2018
Total Practice Duration ~12 Years of Practice (2006 – 2018)

Professional Overview & Biography Verified Profile Summary

Dr. Derrick Johnson, MD was a registered General Practice practicing in Playa Del Rey, CA. Throughout an active medical career spanning 12 years, Dr. Johnson provided care at the practice location at 8700 PERSHING DR until profile deactivation on 2018-06-19.

Practice Location & Contact Primary Location

Practice Address

8700 Pershing Dr
Suite 4313

Playa Del Rey, CA 902938000

Telephone 3104131889

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Playa Del Rey, CA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 31.1 Yrs
Regional Practice Density
1 Specialists

Practicing in Playa Del Rey, CA (2300 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License CA G60418

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated June 19, 2018

Record deactivated on June 19, 2018

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 8700 PERSHING DR, SUITE 4313, PLAYA DEL REY, CA 902938000 (Tel: 3104131889)

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Updated Business Mailing Address July 08, 2007

Registered at 5750 W 79TH ST, LOS ANGELES, CA 900451759 (Tel: 3104131889)

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Provider Name / Credentials Updated July 08, 2007

Recorded as DERRICK JOHNSON, M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

General Practice (License #G60418 in CA)

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Initial NPI Registration & Enumeration September 27, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1114018900
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 27, 2006
Last Update: July 08, 2007
Deactivation Date: June 19, 2018

Mailing Address

5750 W 79th St

Los Angeles, CA 900451759

Phone: 3104131889

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.