KELLY MARIE JOHNSON FNP-C
NPI 1083196554
Nurse Practitioner - Family in Northbrook, IL
About Kelly Marie Johnson Fnp-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY MARIE JOHNSON FNP-C (NPI 1083196554) is an individual family provider in Northbrook, Illinois, licensed in Illinois (209.017943) and active in the NPI registry since August 2018. She has opted out of Medicare through April 17, 2028 and remains eligible to order and refer and maintains a secondary practice location in Chicago.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Opted out of Medicare
Kelly Marie Johnson Fnp-c has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 17, 2024 through April 17, 2028.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 60062 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
NORTHBROOK, IL 60062
NORTHBROOK, IL 60062
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kelly Johnson's NPI number?
The NPI number for Kelly Johnson is 1083196554. It was assigned to this individual provider in the NPPES registry on August 31, 2018.
Where is Kelly Johnson located?
Kelly Johnson practices at 40 Skokie Blvd, Northbrook, IL 60062. The listed phone number is (847) 291-3999.
What is Kelly Johnson's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Kelly Johnson enrolled in Medicare?
No. Kelly Johnson has opted out of Medicare through April 17, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.
When was this NPI record last updated?
The NPPES record for Kelly Johnson was last updated on February 22, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kelly Marie Johnson, FNP-C · NPI 1083196554
Family physician in Northbrook, Illinois. Individual provider, active in the CMS NPPES registry since August 31, 2018.
## Identity
- **NPI:** 1083196554 (Entity type: Individual)
- **Enumerated:** August 31, 2018
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 209.017943 (Illinois)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 40 SKOKIE BLVD, Northbrook, IL 60062-1601
- **Phone:** (847) 291-3999
## Medicare
- **Medicare:** Opted out of Medicare (opt-out affidavit on file, in effect through April 17, 2028); services are provided under private contract
## Record status
- **NPPES last updated:** February 22, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1083196554) · Data from the CMS NPPES public registry.