Mark R Johnson, M.D.

Primary specialty

Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X

License

036-093433 Issued in IL

Practice address

301 N 8TH St
Springfield, IL 62701-1041

Phone

(217) 545-0702

Fax

(217) 545-5834

NPI assigned

Dec 7, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Siu Physicians & Surgeons, Inc

  • Endocrinology, Diabetes & Metabolism Physician
  • Springfield, IL
  • NPI 1558385989
  Medicare reassignment NPD
• Siu Physicians & Surgeons, Inc

  • Durable Medical Equipment & Medical Supplies
  • Springfield, IL
  • NPI 1164055976
  NPD
• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)
• SSM Health Care St. Louis

  • Cardiovascular Disease Physician
  • Bridgeton, MO
  • NPI 1376598599
  NPD (past)
• SSM Health Care St. Louis

  • Emergency Medicine Physician
  • Saint Charles, MO
  • NPI 1427002922
  NPD (past)
• SSM Health Care St. Louis

  • Emergency Medical Services (Emergency Medicine) Physician
  • Lake St Louis, MO
  • NPI 1538113097
  NPD (past)

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1205811775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19639",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949639",
            "telephone_number": "217-545-7578",
            "fax_number": "217-545-1884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N 8TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627011041",
            "telephone_number": "217-545-0702",
            "fax_number": "217-545-5834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARK",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "IL",
            "license": "036-093433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036093433",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "markjohnson@siusm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "301 N 8th St",
            "city": "Springfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "627011041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kelsie M Johnson
• Kevin Johnson, OD
• Kyle Johnson, DPT
• Kyle Michael Johnson, ATC
• Louise Elizabeth Johnson, DT
• Matthew David Johnson, M.D.
• Melissa E Johnson, LCPC
• Nicole R Johnson, APN
• Rebekah Dawn Johnson, LCSW
• Ryan Daniel Johnson, DMD

• Pediatric Pulmonology Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Pediatric Pulmonology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.