Ebony Nicole Johnson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

03612077 Issued in IL

Practice address

4742 Cal Sag Rd
Crestwood, IL 60418

Phone

(708) 915-2727

NPI assigned

Sep 29, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Family Practice

Education

Ohio State University College of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ucm Medical Group Sub LLCGroup PAC ID 4688635337, 101 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ingalls Home Care Inc. Home health agency, Harvey, IL, CCN 147435
• Ingalls Memorial Hospital Hospital, Harvey, IL, CCN 140191
• Community Hospital Hospital, Munster, IN, CCN 150125
• The University of Chicago Medical Center Hospital, Chicago, IL, CCN 140088

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ejohnson179476@uchospital.direct-ci.com

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.

• Ucm Medical Group Sub, LLC

  • Family Medicine Physician
  • Harvey, IL
  • NPI 1467442293
  Medicare reassignment Care Compare group NPD
• Little Company of Mary Affiliated Services Inc

  • Urgent Care Clinic/Center
  • Oak Lawn, IL
  • NPI 1033162086
  Medicare reassignment NPD
• Little Company of Mary Affiliated Services Inc

  • Internal Medicine Physician
  • Evergreen Park, IL
  • NPI 1588617260
  NPD

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

• Ingalls Memorial Hospital

  • General Acute Care Hospital
  • Harvey, IL
  • NPI 1598756686
  Care Compare affiliation
• The University of Chicago Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1508956509
  Care Compare affiliation
• Ucm Home Care

  • Home Health Agency
  • Harvey, IL
  • NPI 1417998865
  Care Compare affiliation
• Munster Medical Research Foundation Inc

  • General Acute Care Hospital
  • Munster, IN
  • NPI 1003918210
  Care Compare affiliation

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532304000000",
    "number": "1497847255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27702 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731277",
            "telephone_number": "708-862-7674",
            "fax_number": "708-862-1781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4742 CAL SAG RD",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "60418",
            "telephone_number": "708-915-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "EBONY",
        "middle_name": "NICOLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-29",
        "last_updated": "2018-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "03612077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J Revello Chiropractic SC
• Sumaieh Jaber, COTA/L
• JBMV Health Associates, LLC
• Arthur Felipe Jimenez, MS, MA, BCBA, LPC
• Cierra D Johnson, PA-C
• Patrice Lanae Johnson, RPH, PMP
• Kelly Jean Jordan
• Thomas I Joseph, MD
• Sejal Kalawadia, MD
• Theresa A Kasick

• Family Medicine Physician in Crestwood, IL
• Providers in Crestwood, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.