Timothy Brian Johnson, D.O.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

036-148417 Issued in IL

Practice address

9730 S Western Ave Ste 100
Evergreen Park, IL 60805-2853

Phone

(708) 425-1907

Fax

(708) 422-4253

NPI assigned

Jun 12, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in TN, MI, VT3 enrollments

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 3

Specialty

Obstetrics/Gynecology

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwestern Medical Center IncGroup PAC ID 5496714313, 105 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwestern Medical Center Inc Hospital, Saint Albans, VT, CCN 470024

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tjohnson404621@direct.stlukeshealth.org
• Direct secure messaging: direct@direct.bronsonhg.org

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.

• Northwestern Medical Center, Inc.

  • General Acute Care Hospital
  • Saint Albans, VT
  • NPI 1538293469
  Medicare reassignment Care Compare group NPD
• Bronson Methodist Hospital

  • Hospitalist Physician
  • Kalamazoo, MI
  • NPI 1417961137

  Obstetrics & Gynecology

  Medicare reassignment NPD
• Gallatin Womens Center, P.C.

  • Specialist
  • Hendersonville, TN
  • NPI 1205956638
  Medicare reassignment
• A Lota Healthcare LTD

  • Obstetrics & Gynecology Physician
  • Mokena, IL
  • NPI 1437755147
  NPD
• Beacon Medical Group, Inc.

  • Family Medicine Physician
  • Mishawaka, IN
  • NPI 1033161617
  NPD
• Beacon Medical Group, Inc.

  • Family Medicine Physician
  • South Bend, IN
  • NPI 1609828946

  Obstetrics & Gynecology

  NPD
• Northwestern Medical Center, Inc

  • Pediatrics Physician
  • Saint Albans, VT
  • NPI 1003574740
  NPD
• Northwestern Medical Center Inc

  • General Acute Care Hospital
  • Saint Albans, VT
  • NPI 1386689875
  NPD (past)

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

• Northwestern Medical Center Inc

  • General Acute Care Hospital
  • Saint Albans, VT
  • NPI 1386689875
  Care Compare affiliation

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

{
    "created_epoch": "1434067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736294400000",
    "number": "1982085247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9730 S WESTERN AVE STE 100",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052853",
            "telephone_number": "708-425-1907",
            "fax_number": "708-422-4253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9730 S WESTERN AVE STE 100",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052853",
            "telephone_number": "708-425-1907",
            "fax_number": "708-422-4253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11885 E 12 Mile Rd Ste 202A",
            "address_purpose": "LOCATION",
            "city": "Warren",
            "state": "MI",
            "postal_code": "480933469",
            "country_code": "US",
            "telephone_number": "586-582-7090",
            "fax_number": "586-582-7091",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10260 191st St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Mokena",
            "state": "IL",
            "postal_code": "604488802",
            "country_code": "US",
            "telephone_number": "708-425-1907",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 John St Ste N1200",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490075318",
            "country_code": "US",
            "telephone_number": "269-341-7979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TIMOTHY",
        "middle_name": "BRIAN",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-12",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "EMC0006076",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "5101021965",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036-148417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "whc@providea.gwaydirect.com",
            "affiliation": "N",
            "endpointDescription": "Women's Healthcare of Illinois",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "9730 S Western Ave Ste 100",
            "city": "Evergreen Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "608052853",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson HealthCare Group Direct Address",
            "affiliationName": "Bronson HealthCare Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Evergreen Park, IL
• Providers in Evergreen Park, IL by specialty
• Obstetrics & Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; 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.