Individual provider Active NPI

Kimberly Leona Johnson-Davis, MD

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1346407319
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
125-051280 Issued in IL
Practice address
736 W 95TH St
Halsted Medical Center
Chicago, IL 60628-1063
Phone
(773) 487-0363
Fax
(708) 229-6071
NPI assigned
May 19, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 125-051280 IL Primary

Addresses

Primary practice location

736 W 95TH St
Halsted Medical Center
Chicago, IL 60628-1063

Mailing address

736 W 95TH St
Halsted Medical Center
Chicago, IL 60628-1063
Phone (773) 487-0363

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130917000559 IL Practitioner - Family Practice 9537303318 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rush Medical College of Rush University, 2009
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2800 W 95TH St
Evergreen, IL 60805-2701

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125-051280ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nuway Community Services Inc CurrentSince Jan 5, 2026 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Nov 30, 2019 Accepting new patients
Little Company of Mary Affiliated Services Inc CurrentSince Aug 1, 2013 Accepting new patients
Little Company of Mary Affiliated Services Inc Current Accepting new patients

Locations

110 E 79th St
Chicago, IL 60619
Phone (773) 419-4214

736 W 95th St
Chicago, IL 60628
Phone (773) 487-0363

2800 W 87th St
Chicago, IL 60652
Phone (312) 423-4200

12450 S Harlem Ave
Palos Heights, IL 60463
Phone (708) 448-1207

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751328000000",
    "number": "1346407319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "736 W 95TH ST",
            "address_2": "HALSTED MEDICAL CENTER",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606281063",
            "telephone_number": "773-487-0363",
            "fax_number": "708-229-6071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "736 W 95TH ST",
            "address_2": "HALSTED MEDICAL CENTER",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606281063",
            "telephone_number": "773-487-0363",
            "fax_number": "708-229-6071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON-DAVIS",
        "first_name": "KIMBERLY",
        "middle_name": "LEONA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-19",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125-051280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.