Jazmin Nicole Johnson, DMD
Individual provider Active NPI Dentist · Galesburg, IL
NPI 1487542353 · NPPES record last updated Jun 27, 2025
Key facts
- NPI
- 1487542353
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019.036186 (IL)
- Practice address
- 1361 W Fremont St
Galesburg, IL 61401-2436 - Phone
- (309) 344-2224
- NPI assigned
- Jun 27, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Dentist
- Education
- Other, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1361 W Fremont St
Galesburg, IL 61401-2436
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251029001089 | IL | Practitioner - Dentist | 4880183938 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.036186 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Knox | Current | Accepting new patients | |
| Knox Community Health Center NFP | Current |
Accepting new patients |
Locations
1361 W Fremont St
Galesburg, IL 61401
Phone (309) 344-2224
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/HJHHBD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.036186 | IL | Yes |
Addresses
Primary practice location
1361 W Fremont St
Galesburg, IL 61401-2436
Mailing address
1361 W Fremont St
Galesburg, IL 61401-2436
Other providers in Galesburg, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.