Johnny J Hernandez, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

10 Heartland Dr
Suite a
Bloomington, IL 61704-7741

Phone

(309) 662-0523

Fax

(309) 662-7693

NPI assigned

Apr 6, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Dec 31, 2014 through Dec 31, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073636130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13715 FAWN DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047834",
            "telephone_number": "309-828-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 HEARTLAND DR",
            "address_2": "SUITE A",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047741",
            "telephone_number": "309-662-0523",
            "fax_number": "309-662-7693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "JOHNNY",
        "middle_name": "J",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heritage Manor - Lasalle, LLC
• Heritage Manor Bloomington, LLC
• Christopher M Herman, MD
• Robert J Hermann, D.C.
• Kiran Elizabeth Hermon
• Yulissa Hernandez
• Kylee Kinsella Hess
• Rachael Josephine Hewson, ATC
• Matt Hickman, LCPC
• Camryn E Hicks

• General Practice Dentistry in Bloomington, IL
• Providers in Bloomington, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.