David Martin Johnson, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

Practice address

2300 N Edward STR
Decatur, IL 62526

Phone

(217) 876-5021

Fax

(217) 876-5013

NPI assigned

Aug 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922014455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6450 RELIABLE PARKWAY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60686",
            "telephone_number": "217-788-3000",
            "fax_number": "217-788-5577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 N EDWARD STR",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "62526",
            "telephone_number": "217-876-5021",
            "fax_number": "217-876-5013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DAVID",
        "middle_name": "MARTIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360580891",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jessica Marie Johnson, O.D.
• Mallory Noel Johnson
• Margaret Ellen Johnson, LCSW
• Nicholas Johnson
• Pierre Michael Johnson, M.D.

• Anatomic Pathology & Clinical Pathology Physician in Decatur, IL
• Providers in Decatur, IL by specialty
• Anatomic Pathology & Clinical Pathology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.