Active NPI
Reginald Deon Johnson
- Driver
- Glen Carbon, IL
National Provider Identifier
1356029482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- T980502029
- Practice address
- 3 Quail Hollow CT Apt a
Glen Carbon, IL 62034-2920 - Phone
- (618) 954-5885
- NPI assigned
- Jul 10, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | T980502029 | MO | Primary |
Addresses
Primary practice location
3 Quail Hollow CT Apt a
Glen Carbon, IL 62034-2920
Mailing address
3 Quail Hollow CT Apt a
Glen Carbon, IL 62034-2920
Phone (618) 954-5885
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T980502029 | MO | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688947200000",
"number": "1356029482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 QUAIL HOLLOW CT APT A",
"city": "GLEN CARBON",
"state": "IL",
"postal_code": "620342920",
"telephone_number": "618-954-5885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 QUAIL HOLLOW CT APT A",
"city": "GLEN CARBON",
"state": "IL",
"postal_code": "620342920",
"telephone_number": "618-954-5885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "REGINALD",
"middle_name": "DEON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-10",
"last_updated": "2023-07-10",
"certification_date": "2023-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "MO",
"license": "T980502029",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Carbon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.