Brendon J Johnson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046009489 Issued in IL

Practice address

2611 Broadway St
Pekin, IL 61554-2501

Phone

(309) 347-5989

Fax

(309) 347-4315

NPI assigned

May 8, 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 3

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

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

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.

• Brendon J Johnson, OD, PC

  • Optometrist
  • Pekin, IL
  • NPI 1568647790
  Medicare reassignment NPD Authorized official
• Illinois Retina Institute, SC

  • Ophthalmology Physician
  • Peru, IL
  • NPI 1003875436
  NPD (past)
• Professional Therapy Services, Inc

  • Physical Therapist
  • Pekin, IL
  • NPI 1578615225
  NPD (past)

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672272000000",
    "number": "1194774174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2611 BROADWAY ST",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615542501",
            "telephone_number": "309-347-5989",
            "fax_number": "309-347-4315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 BROADWAY ST",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615542501",
            "telephone_number": "309-347-5989",
            "fax_number": "309-347-4315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BRENDON",
        "middle_name": "J",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-08",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046009489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/SHIELD OF IL",
            "identifier": "09032051",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046009489",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "563081",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessie Shanks Counseling, Inc.
• Lakeia Jimerson
• Rhonda Diane Jockisch, R.PH.
• Jodi Knox-Holub LLC
• Abigail Leigh Johnson, APRN, CNP
• Danielle Johnson, PA
• Kirk Johnson, DPT
• Robert Joel Johnson, D.M.D.
• Teah Marie Johnson, AU.D
• Lisa Rene Jones, PHD, LCPC

• Optometrist in Pekin, IL
• Providers in Pekin, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2022; 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.