Active NPI
Douglas R. Johnston, MD
- Pediatric Otolaryngology Physician
- Chicago, IL
National Provider Identifier
1659581262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Otolaryngology Physician
- License
- 036141921
- Practice address
- 225 E Chicago Ave
Chicago, IL 60611 - Phone
- (800) 543-7362
- Fax
- (312) 227-9414
- NPI assigned
- May 23, 2007
- Last updated
- May 22, 2020
- 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 |
|---|---|---|---|---|
| Pediatric Otolaryngology Physician | 207YP0228X | 036141921 | IL | Primary |
Addresses
Primary practice location
225 E Chicago Ave
Chicago, IL 60611
Mailing address
225 E Chicago Ave
Chicago, IL 60611-2991
Phone (800) 543-7362
Other practice location 1
1600 Rockland Road
Wilmington, DE 19803-3607
Phone (302) 651-4200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036141921 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036141921 | IL | MD | Pediatric Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lurie Children's Medical Group, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590105600000",
"number": "1659581262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 E CHICAGO AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606112991",
"telephone_number": "800-543-7362",
"fax_number": "312-227-9414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 E CHICAGO AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60611",
"telephone_number": "800-543-7362",
"fax_number": "312-227-9414"
}
],
"practiceLocations": [
{
"address_1": "1600 Rockland Road",
"address_purpose": "LOCATION",
"city": "Wilmington",
"state": "DE",
"postal_code": "198033607",
"country_code": "US",
"telephone_number": "302-651-4200",
"fax_number": "302-651-5990",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JOHNSTON",
"first_name": "DOUGLAS",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-23",
"last_updated": "2020-05-22",
"certification_date": "2020-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "207YP0228X",
"taxonomy_group": "",
"desc": "Otolaryngology, Pediatric Otolaryngology",
"state": "IL",
"license": "036141921",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036141921",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.