Individual provider Active NPI

Johnathan Patrick Lewis, DO

  • Emergency Medicine Physician
  • Oak Park, IL
National Provider Identifier
1417517236
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036163696 Issued in IL
Practice address
520 S Maple Ave
Oak Park, IL 60304-1022
Phone
(708) 660-5997
Fax
(630) 660-2251
NPI assigned
Jun 14, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 5151014031 MI
Emergency Medicine Physician 207P00000X 036163696 IL Primary

Addresses

Primary practice location

520 S Maple Ave
Oak Park, IL 60304-1022

Mailing address

520 S Maple Ave
Oak Park, IL 60304-1022
Phone (708) 660-5997

Other practice location 1

1700 Clinton St
Muskegon, MI 49442-5502
Phone (231) 728-4936

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20211005001121 MI Practitioner - Emergency Medicine 7719385871 Reassigns benefits to 1 organization
I20230626001914 IL Practitioner - Emergency Medicine 7719385871 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Michigan State University College of Osteopathic Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rush University Medical GroupGroup PAC ID 5496658874, 1,521 clinicians
Rush Oak Park ER Physicians GroupGroup PAC ID 8820190606, 29 clinicians

Practice addresses (Care Compare)

520 S Maple Ave
Oak Park, IL 60304-1022
Phone (708) 660-2240

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036163696ILMDEmergency Medicine Physician
5151014031MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Rush University Medical Group Emergency Medicine CurrentSince Aug 1, 2025 Accepting new patients
Rush Oak Park ER Physicians Group CurrentSince Jul 1, 2023 Accepting new patients
Mercy Health Partners CurrentSince Oct 1, 2021 Accepting new patients
Mercy Health Partners CurrentSince Oct 1, 2021 Accepting new patients
Rush University Medical Center CurrentSince Aug 1, 2025 Accepting new patients
Lake Michigan Emergency Specialists, PLLC Emergency Medicine CurrentSince Jul 1, 2022 Accepting new patients

Locations

75 Remittance Dr
Dept 1611
Chicago, IL 60675

1653 W Congress Pkwy
Chicago, IL 60612
Phone (312) 942-3138

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

75 Remittance Dr
Dept 1620
Chicago, IL 60675

520 S Maple Ave
Oak Park, IL 60304
Phone (708) 383-9300

1700 Clinton St
Muskegon, MI 49442
Phone (231) 726-3511

71 Bevier St
Shelby, MI 49455
Phone (231) 861-2172

72 S State St
Shelby, MI 49455
Phone (231) 728-4601

905 E Colby St
Whitehall, MI 49461
Phone (231) 672-8050

Organizations & group practices 6

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 1

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": "1560470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684195200000",
    "number": "1417517236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 S MAPLE AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603041022",
            "telephone_number": "708-660-5997",
            "fax_number": "630-660-2251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 S MAPLE AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603041022",
            "telephone_number": "708-660-5997",
            "fax_number": "630-660-2251"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 Clinton St",
            "address_purpose": "LOCATION",
            "city": "Muskegon",
            "state": "MI",
            "postal_code": "494425502",
            "country_code": "US",
            "telephone_number": "231-728-4936",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "JOHNATHAN",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-14",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "5151014031",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036163696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Park, IL

Sources for this page

Verify at the official NPI Registry.