DR. KENDRICK DEWAYNE JOHNSON (NPI# 1790122141) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790122141 |
| Entity Type | Individual |
| Full Name | DR. KENDRICK DEWAYNE JOHNSON |
| Credential | M.D. |
| Practice Address |
Osf St Francis Medical Ctr 530 N.e. Glen Oak Ave Peoria IL 61637-0001 |
| Mailing Address |
9045 Kingston Rd Apt 2906 Shreveport LA 71118-3466 |
| Practice Telephone | 3096552642 |
| Mailing Telephone | 3184269287 |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2013-05-24 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207T00000X | Neurological Surgery | 125.063144 | IL | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558700054 | Kendrick O Johnson | Family Medicine | 2000 W Bethany Home Rd, Phoenix, AZ 85015-2443 | 2013-06-18 |
| 1275971715 | Kendrick C Johnson | Nurse Anesthetist, Certified Registered | 13737 Noel Rd Ste 1400, Dallas, TX 75240-2004 | 2013-06-06 |
| 1780720979 | Kendrick Millard Johnson | Emergency Medicine | 1650 Creekside Dr, Folsom, CA 95630-3400 | 2007-01-29 |
| Street Address |
OSF ST FRANCIS MEDICAL CTR 530 N.E. GLEN OAK AVE |
| City | PEORIA |
| State | IL |
| Zip Code | 61637-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386659241 | Central Illinois Radiological Associates, Ltd. | Radiology | Osf St Francis Medical Ctr, 530 N.e. Glen Oak, Peoria, IL 61636-0001 | 2006-07-29 |
| 1336526524 | Ammar Ahmed | Student in an Organized Health Care Education/Training Program | Osf St Francis Medical Ctr, 530 Ne Glen Oak Ave, Sfnb 2624, Peoria, IL 61637-0001 | 2015-04-27 |
| 1528477015 | Dianne Maria Endress | Nurse Practitioner | Osf St Francis Medical Ctr, 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2014-08-08 |
| 1295173789 | Paul Miles Macmahon | Neurological Surgery | Osf St Francis Medical Ctr, 530 N.e. Glen Oak Ave, Peoria, IL 61637-0001 | 2013-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780200865 | Kuang Chuen Liu | Pediatrics | 530 Ne Glen Oak Ave, Peoria, Peoria, IL 61637 | 2020-06-24 |
| 1174184527 | Manisha Tharoor | Student in an Organized Health Care Education/Training Program | 530 N.e Glen Oak Ave, Peoria, IL 61637 | 2019-06-26 |
| 1609436724 | Sriviji Senthil Kumaran | Student in an Organized Health Care Education/Training Program | 530. N.e Glen Oak Ave., Peoria, IL 61637 | 2019-06-20 |
| 1780240929 | Abuzar Ali Asif | Student in an Organized Health Care Education/Training Program | 530 N. E. Glen Oak Ave., Peoria, IL 61637 | 2019-05-14 |
| 1518328665 | Jenna Bishop | Dietitian, Registered | 600 Ne Water Street, Peoria, IL 61637 | 2016-03-17 |
| 1194133850 | Ashish Kumar Roy | Internal Medicine | 530 N.e. Glen Oak Ave, Peoria, IL 61637 | 2014-07-25 |
| 1265720510 | Reuben Antony | Pediatrics | 530 Ne Glen Oak Ave., C/o Ms Suzy Lewellen, Peoria, IL 61637 | 2011-07-20 |
| 1366673436 | Joseph William Hauter | Emergency Medicine | 830 Ne Glen Oak Ave, Peoria, IL 61637 | 2009-08-06 |
| 1437380748 | Jeremy R Monroe | Emergency Medicine | 530 Glen Oak, Osf St Francis Medical Center, Peoria, IL 61637 | 2009-08-04 |
| 1326244682 | Maria S. Parr | Psychiatry & Neurology | Osf Saint Francis Medical Center, 530 N.e.glen Oak Ave., Peoria, FL 61637 | 2007-06-25 |
| Find all providers in zip 61637 | ||||
| Taxonomy Code | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003861634 | Patrick William Elwood | Neurological Surgery | 719 N William Kumpf Blvd, Suite 100, Peoria, IL 61605 | 2006-05-23 |
| 1295185056 | Thomas Morison Russell | Neurological Surgery | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2016-06-13 |
| 1700235280 | Nolan Winslow | Neurological Surgery | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2016-06-06 |
| 1790167559 | Daniel Vollhaber | Neurological Surgery | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2015-06-29 |
| 1053793315 | Max Kahn | Neurological Surgery | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2015-06-23 |
| 1720493000 | Sujit Bhimireddy | Neurological Surgery | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2014-06-25 |
| 1295173789 | Paul Miles Macmahon | Neurological Surgery | Osf St Francis Medical Ctr, 530 N.e. Glen Oak Ave, Peoria, IL 61637-0001 | 2013-06-06 |
| 1326485921 | Illinois Neuroscience Institute | Neurological Surgery | 100 Ne Randolph Ave, Peoria, IL 61606-1919 | 2013-05-23 |
| 1043506942 | Derek Martinez | Neurological Surgery | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2011-06-20 |
| 1467765040 | Andres L Maldonado | Neurological Surgery | 200 E Pennsylvania Ave, Peoria, IL 61603-3089 | 2010-07-23 |
| Find all providers in PEORIA | ||||
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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.