Matthew T. Johnson MD, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MATTHEW T. JOHNSON MD, PC

Practice address

344 Victory Dr
Park Forest, IL 60466-2003

Phone

(708) 481-0100

NPI assigned

Dec 30, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Matthew Todd Johnson, M.D.

Title

Managing Partner

Phone

(708) 481-0100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Park Forest Family Practice Doing business as

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

{
    "created_epoch": "1167436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195084800000",
    "number": "1144386202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "344 VICTORY DR",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604662003",
            "telephone_number": "708-481-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "344 VICTORY DR",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604662003",
            "telephone_number": "708-481-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW T. JOHNSON MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-30",
        "last_updated": "2007-11-15",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "708-481-0100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ID#",
            "identifier": "01634105",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Forest Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Denise Michelle Mangrum, DT
• Tracey Marie Mayfield, OTR/L
• Kimberly Ann McArthur, MSW, LSW
• Shirley P. McDonald, MSW
• Antrone McIntosh
• Avery Natasha McShan, CD

• Family Medicine Physician in Park Forest, IL
• Providers in Park Forest, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; 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.