Individual provider Active NPI

Troy W Johnson, OD

  • Optometrist
  • Scott Air Force Base, IL
National Provider Identifier
1316091887
Registry record updated Oct 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046009783 Issued in IL
Practice address
310 W Losey St
Scott Air Force Base, IL 62225-5250
Phone
(618) 256-7361
Fax
(618) 256-7516
NPI assigned
Jan 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046009783 IL Primary

Addresses

Primary practice location

310 W Losey St
Scott Air Force Base, IL 62225-5250

Mailing address

310 W Losey St
Scott Air Force Base, IL 62225-5250
Phone (618) 256-7361

Other identifiers 1

IdentifierTypeStateIssuer
P00321579OtherPALMETTO GBA

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050927000993 IL Practitioner - Optometry 2567497704 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clarkson Optometry Illinois, PCGroup PAC ID 7012292147, 16 clinicians

Practice addresses (Care Compare)

3000 Broadway St
Mount Vernon, IL 62864-2340
Phone (618) 242-4141

Merit-based Incentive Payment System (MIPS)

Final score
40.19 of 100Reported as individual
Quality
45.81
Promoting interoperability
0
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery99

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046009783ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Clarkson Optometry Illinois, P.C. Optometrist CurrentSince Jun 1, 2017 Accepting new patients
Clarkson Optometry Illinois, P.C. Optometrist CurrentSince Jun 1, 2017 Accepting new patients
JFJ Eyecare, LTD Optometrist CurrentSince Jan 1, 2013 Accepting new patients
Illinois Retina Surgery LTD Past Accepting new patients
Clarkson Optometry Illinois PC Optometrist Past Accepting new patients

Locations

111 W Lincoln St
Belleville, IL 62220
Phone (618) 234-1774

2525 Green Mount Commons Dr
Ste 290
Belleville, IL 62221
Phone (618) 233-7800

103 Clintonian Plz
Breese, IL 62230
Phone (618) 526-7447

408 W 2nd St
Centralia, IL 62801
Phone (618) 532-5531

601 Belt Line Rd
Collinsville, IL 62234
Phone (618) 223-5212

1025 Columbia Centre
Columbia, IL 62236
Phone (618) 281-8611

2121 S State Route 157
Edwardsville, IL 62025
Phone (618) 656-7774

12 Professional Park Dr
Maryville, IL 62062
Phone (618) 288-7266

3000 Broadway St
Mount Vernon, IL 62864
Phone (618) 242-4141

400 N Broadway Ave
Salem, IL 62881
Phone (618) 548-3506

3248 Green Mount Crossing Dr
Shiloh, IL 62269
Phone (618) 622-9225

3990 N Illinois St
Swansea, IL 62226
Phone (618) 235-3100

Interoperability endpoints

  • Direct secure messaging: troyjohnson@direct.eyecare-partners.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222992000000",
    "number": "1316091887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AIR FORCE BASE",
            "state": "IL",
            "postal_code": "622255250",
            "telephone_number": "618-256-7361",
            "fax_number": "618-256-7516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AIR FORCE BASE",
            "state": "IL",
            "postal_code": "622255250",
            "telephone_number": "618-256-7361",
            "fax_number": "618-256-7516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TROY",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2008-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046009783",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "P00321579",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scott Air Force Base, IL

Sources for this page

Verify at the official NPI Registry.