Active NPI
Ryan Bruce Johnson, DO
- Anesthesiology Physician
- Chicago, IL
National Provider Identifier
1033800412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 125.081706
- Practice address
- 1750 W Harrison St Ste 739
Chicago, IL 60612-3825 - Phone
- (312) 942-3134
- NPI assigned
- May 17, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 125.081706 | IL | Primary |
Addresses
Primary practice location
1750 W Harrison St Ste 739
Chicago, IL 60612-3825
Mailing address
19400 MC Kinley CT
Shorewood, MN 55331-8119
Phone (651) 328-3717
Medicare participation
Medicare enrollment files- 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: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230810001855 | IL | Order and Referring Only - Anesthesiology | 5597127381 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.081706 | IL | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684713600000",
"number": "1033800412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19400 MC KINLEY CT",
"city": "SHOREWOOD",
"state": "MN",
"postal_code": "553318119",
"telephone_number": "651-328-3717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1750 W HARRISON ST STE 739",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123825",
"telephone_number": "312-942-3134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "RYAN",
"middle_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-17",
"last_updated": "2023-05-22",
"certification_date": "2023-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "IL",
"license": "125.081706",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.