Ansel T Johnson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046007826 Issued in IL

Practice address

12812 Western Ave
Blue Island, IL 60406-2118

Phone

(708) 385-0013

Fax

(708) 385-1175

NPI assigned

Oct 11, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

New England College of Optometry, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Vision Salon, LTD.Group PAC ID 0345143855, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• The Vision Salon, LTD.

  • Optometrist
  • Blue Island, IL
  • NPI 1487727046
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600646400000",
    "number": "1023106309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12812 WESTERN AVE",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604062118",
            "telephone_number": "708-385-0013",
            "fax_number": "708-385-1175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12812 WESTERN AVE",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604062118",
            "telephone_number": "708-385-0013",
            "fax_number": "708-385-1175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ANSEL",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046007826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSIL ID",
            "identifier": "1636075",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046007826",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC PIN",
            "identifier": "0718670001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "363718601",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE PIN",
            "identifier": "410011831",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keshawn Jackson
• Petrina F Jackson, M.S., CCC-SLP
• Julie A Jansky, PHARM D
• Faheem M Jesani, D.O.
• Martin Jay Joffe, MD
• Leonidas A Johnson, OD
• Corine Jones
• Gina Jones, LMT
• Jessica Jones
• Julieta Jones, RN, BSN

• Optometrist in Blue Island, IL
• Providers in Blue Island, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.