Active NPI
Jessica Johnson, DPM
- Foot & Ankle Surgery Podiatrist
- Streator, IL
National Provider Identifier
1790076289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- PO 3668
- Practice address
- 1014 Lowden Rd
Streator, IL 61364-1418 - Phone
- (815) 674-0980
- NPI assigned
- May 2, 2011
- Last updated
- Aug 7, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | PO 3668 | FL | Primary |
Addresses
Primary practice location
1014 Lowden Rd
Streator, IL 61364-1418
Mailing address
1014 Lowden Rd
Streator, IL 61364-1418
Phone (815) 674-0980
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PO 3668 | FL | MD | Foot & Ankle Surgery Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407369600000",
"number": "1790076289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1014 LOWDEN RD",
"city": "STREATOR",
"state": "IL",
"postal_code": "613641418",
"telephone_number": "815-674-0980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1014 LOWDEN RD",
"city": "STREATOR",
"state": "IL",
"postal_code": "613641418",
"telephone_number": "815-674-0980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JESSICA",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-02",
"last_updated": "2014-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "FL",
"license": "PO 3668",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Streator, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.