Colleen Maroney Johnson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

60072-20 Issued in WI

Practice address

8600 75TH St Ste 101
Kenosha, WI 53142-8200

Phone

(262) 652-9430

Fax

(262) 652-9433

NPI assigned

Mar 25, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Colleen Maroney-Rutter Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: cmaroneyrutter6404@direct.chw.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Children'S Medical Group

  • Pediatrics Physician
  • Glendale, WI
  • NPI 1134394471
  NPD (past)
• Children'S Medical Group

  • Pediatrics Physician
  • Kenosha, WI
  • NPI 1427223783
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1013216308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "MAIL STATION 958",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-7615",
            "fax_number": "414-266-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 75TH ST STE 101",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531428200",
            "telephone_number": "262-652-9430",
            "fax_number": "262-652-9433"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5433 W Fond Du Lac Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532161382",
            "country_code": "US",
            "telephone_number": "414-277-8900",
            "fax_number": "414-277-8939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "COLLEEN",
        "middle_name": "MARONEY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-25",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "60072-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013216308",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLEEN",
            "last_name": "MARONEY-RUTTER",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Debra Johansen, PHD
• John C Matteucci Jr MD SC
• John P Rende DDS SC
• Alayna Johnson, OTR
• Amiya Jada Johnson, APRN
• Ebba M Johnson, PT
• Jennifer Ann Johnson
• Jennifer J Johnson, RN
• Jerrilyn Johnson, PA-C
• Katherine Anne Johnson

• Pediatrics Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Pediatrics Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.