GREGORY L JOHNSON (NPI# 1417922857) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417922857 |
| Entity Type | Individual |
| Full Name | GREGORY L JOHNSON |
| Credential | M.D. |
| Practice Address |
900 Main St Suite 100 Peoria IL 61602-1005 |
| Practice Telephone | 3096724908 |
| Practice Fax Number | 3096724272 |
| Mailing Telephone | 3096724908 |
| Mailing Fax Number | 3096724272 |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2013-01-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
036115494 | IL | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568080505 | Gregory L Johnson | Student in an Organized Health Care Education/Training Program | W165n10212 Wagon Trl, Germantown, WI 53022-4747 | 2020-07-07 |
| 1780213405 | Gregory Johnson | Student in an Organized Health Care Education/Training Program | 534 S Field St, Lakewood, CO 80226-2957 | 2020-04-04 |
| 1912462789 | Gregory Johnson | Technician | 2001 15th St Nw # W1012, Washington, DC 20009-5828 | 2019-02-06 |
| 1558877134 | Gregory Wallace Johnson | Radiology | 769 W 1900 S, Woods Cross, UT 84087-1720 | 2017-12-19 |
| 1770004764 | Gregory Nathan Johnson | Physical Therapist | 200 E Idaho St Ste A, Kalispell, MT 59901-4117 | 2017-06-29 |
| 1497295349 | Gregory Johnson | Behavior Technician | 831 W Woodward Ave, Eustis, FL 32726-4562 | 2017-02-26 |
| 1205202140 | Gregory Kent Johnson | Dentist | 650 E. 25th Street, Umkc School of Dentistry, Kansas City, MO 64108 | 2015-08-14 |
| 1932507571 | Gregory Johnson | Specialist/Technologist | 7925 W Mansfield Pkwy Unit 303, Lakewood, CO 80235-1955 | 2014-12-14 |
| 1093080228 | Gregory Paul Johnson | Physical Therapist | 986 Quail Rdg, Keller, TX 76248-2925 | 2012-03-21 |
| 1588962054 | Gregory Earl Johnson | Counselor | 915 E Main St, Watonga, OK 73772-4626 | 2011-03-08 |
| Street Address |
900 MAIN ST SUITE 100 |
| City | PEORIA |
| State | IL |
| Zip Code | 61602-1005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295260784 | Alexandra Gens | Psychiatry & Neurology | 900 Main St, Suite 720, Peoria, IL 61602-1005 | 2017-04-22 |
| 1407380751 | Unitypoint Health Methodist | Psychiatry & Neurology | 900 Main St, Suite 720, Peoria, IL 61602-1005 | 2017-04-13 |
| 1669823068 | Kory Jackson | Nurse Practitioner | 900 Main St, Ste 100, Peoria, IL 61602-1005 | 2016-06-27 |
| 1932554714 | Jamie Schupbach | Nurse Practitioner | 900 Main St, Ste 600, Peoria, IL 61602-1005 | 2016-04-28 |
| 1407223969 | Teresa Michelle Watts | Nurse Practitioner | 900 Main St, Suite 100, Peoria, IL 61602-1005 | 2015-08-31 |
| 1487054433 | Christina Lowrance | Nurse Practitioner | 900 Main St, Peoria, IL 61602-1005 | 2014-08-27 |
| 1295158194 | Karolina Wozny | Physician Assistant | 900 Main St, Suite 630, Peoria, IL 61602-1005 | 2014-01-28 |
| 1821423583 | Radha K Chathadi | Registered Nurse | 900 Main St, Suite 630, Peoria, IL 61602-1005 | 2013-09-12 |
| 1558796789 | Erin Surratt | Social Worker | 900 Main St, Suite 400, Peoria, IL 61602-1005 | 2013-09-06 |
| 1336490333 | Susan Copp | Nurse Practitioner | 900 Main St, Suite 600, Peoria, IL 61602-1005 | 2012-10-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720574676 | Critical Care Rx, LLC | Pharmacy | 126 Oak St, Peoria, IL 61602 | 2018-07-03 |
| 1235675836 | Cheryl Beckman | Registered Nurse | 211 Fulton Street, Suite 207, One Technology Plaza, Peoria, IL 61602 | 2017-01-06 |
| 1063957942 | Rosemary Ince | Registered Nurse | 211 Fulton St. Suite 207, One Technology Plaza, Peoria, IL 61602 | 2016-12-30 |
| 1962674820 | Lisa Jean Burckhartzmeyer | Psychiatry & Neurology | 228 Ne Jefferson St, Peoria, IL 61602 | 2008-03-31 |
| 1669503587 | Jill Larson | Counselor | 330 Sw Washington Street, Peoria, IL 61602 | 2007-03-09 |
| 1265407399 | Cardiac Consultants Sc | Internal Medicine | 900 Main Street, Suite 320, Peoria, IL 61602 | 2006-02-22 |
| 1013364470 | Rafal Szymczuk | Student in an Organized Health Care Education/Training Program | 900 Main Street, Suite 720, Peoria, IL 61602 | 2016-05-16 |
| 1043693831 | Kari Beth Watts | Family Medicine | 815 Main St, Peoria, IL 61602 | 2015-06-30 |
| 1881072791 | Kristen Dent | Family Medicine | 815 Main St, Peoria, IL 61602 | 2015-05-12 |
| 1023422797 | Andrew Wang | Psychiatry & Neurology | 900 Main St Ste 580, Peoria, IL 61602 | 2014-06-20 |
| Find all providers in zip 61602 | ||||
| Taxonomy Code | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790399327 | Karen Louise Mcallister | Family Medicine | 1556 N State Rd, Flora, IL 62839-3233 | 2020-09-01 |
| 1780205708 | Cook County | Family Medicine | 12757 S. Western Ave, Blue Island, IL 60406 | 2020-04-30 |
| 1982225918 | Welcome Health Management Group | Family Medicine | 2325 W Harrison St Apt 2, Chicago, IL 60612-3555 | 2020-04-30 |
| 1043702830 | Professional Healthcare Inc | Family Medicine | 960 Rand Rd Ste 224, Des Plaines, IL 60016 | 2018-06-06 |
| 1578078754 | Innovative Geriatrics LLC | Family Medicine | 301 Madison St Ste 310, Joliet, IL 60435-6686 | 2017-12-09 |
| 1033507249 | Bridgecare, Inc. | Family Medicine | 2250 E Devon Ave, Suite 333, Des Plaines, IL 60018-4511 | 2014-12-23 |
| 1700218385 | Camilla Lim | Family Medicine | 309 Ridgemoor Dr, Willowbrook, IL 60527-5416 | 2013-08-06 |
| 1073807707 | Lr Health Management, Inc | Family Medicine | 1204 S 57th Ave, Cicero, IL 60804-1148 | 2011-05-28 |
| 1770884561 | Dr Gandhi Inc | Family Medicine | 1404 English Ct, Naperville, IL 60564-5187 | 2010-11-10 |
| 1285941914 | Shifa Medical Care, Inc | Family Medicine | 142 E Lake St, Suite C, Bloomingdale, IL 60108-1195 | 2010-09-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.