Individual provider Active NPI

Sara Johnson, M.D.

  • Emergency Medicine Physician
  • Berwyn, IL
National Provider Identifier
1730286519
Registry record updated Jan 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036-107859 Issued in IL
Practice address
3249 Oak Park Ave
Berwyn, IL 60402-3429
Phone
(708) 783-9100
NPI assigned
Sep 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036-107859 IL Primary

Addresses

Primary practice location

3249 Oak Park Ave
Berwyn, IL 60402-3429

Mailing address

212 N Ridgeland Ave
Oak Park, IL 60302-2323
Phone (708) 383-0568

Other identifiers 1

IdentifierTypeStateIssuer
036107859MedicaidIL

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: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-107859ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cepamerica Illinois LLP Emergency Medicine Current Accepting new patients
Cepamerica Illinois LLP Emergency Medicine CurrentSince Jan 1, 2012 Accepting new patients
Cepamerica Illinois LLP Emergency Medicine CurrentSince Jan 1, 2012 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

1425 N Randall Rd
Elgin, IL 60123
Phone (224) 783-5437

1225 W Lake St
Melrose Park, IL 60160
Phone (708) 681-3000

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231459200000",
    "number": "1730286519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 N RIDGELAND AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603022323",
            "telephone_number": "708-383-0568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3249 OAK PARK AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023429",
            "telephone_number": "708-783-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SARA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2009-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-107859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036107859",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, IL

Sources for this page

Verify at the official NPI Registry.