GREGORY L JOHNSON M.D. NPI 1417922857

Family Medicine (Geriatric Medicine) in Peoria, IL

About GREGORY JOHNSON

Gregory Johnson is a provider in Peoria, IL with more than 15 years of experience. The NPI number assigned to this provider is 1417922857. The practitioner's primary taxonomy code is Family Medicine (207QG0300X). The provider is registered as an individual and their NPI record was last updated 5 years ago. Gregory Johnson is registered with Medicare and accepts claims assignment.

NPI1417922857 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Name GREGORY L JOHNSON M.D.
Provider Location Address900 MAIN ST SUITE 100 PEORIA, IL 61602 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address900 MAIN ST SUITE 100 PEORIA, IL 61602 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderMale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Medical School NameUNIVERSITY OF ILLINOIS AT CHICAGO HEALTH SCIENCE CENTER
Graduation Year2003
Is Sole Proprietor?No
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date02-21-2006 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date01-31-2013 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

GREGORY L JOHNSON M.D.
900 MAIN ST
SUITE 100
PEORIA, IL
ZIP 61602
Phone: (309) 672-4908
Fax: (309) 672-4272
Get Directions

Mailing Address

GREGORY L JOHNSON M.D.
900 MAIN ST
SUITE 100
PEORIA, IL
ZIP 61602
Phone: (309) 672-4908
Fax: (309) 672-4272

Primary Taxonomy

Taxonomy Code207QG0300X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
SpecializationGeriatric Medicine
License No.036115494
License StateIL
Taxonomy DescriptionA family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
PENDINGMEDICARE ID-TYPE UNSPECIFIED (04)

Map Location


GREGORY L JOHNSON M.D. address is 900 MAIN ST SUITE 100 PEORIA, IL 61602

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1023052818 KAREN MARGARET KYLE M.D.
Individual
Psychiatry & Neurology (Psychiatry)900 MAIN ST SUITE 580
PEORIA, IL 61602
(309) 637-4266
1023179967 CATHERINE J KILBOURN LCSW
Individual
Social Worker (Clinical)900 MAIN ST SUITE 580
PEORIA, IL 61602
(309) 637-4266
1093854002MID ILLINI SURGICAL ASSOCIATES SC
Organization
Surgery900 MAIN ST SUITE 530
PEORIA, IL 61602
(309) 672-5975
1124063987MICHAEL D. CASHMAN, M.D., S.C.
Organization
Internal Medicine (Gastroenterology)900 MAIN ST SUITE 490
PEORIA, IL 61602
(309) 671-8313
1154302602DR. JEFFREY L WILLIAMSON MD
Individual
Surgery900 MAIN ST SUITE 530
PEORIA, IL 61602
(309) 672-5975
1154336691 SHOBHA NOOKALA MD
Individual
Psychiatry & Neurology (Child & Adolescent Psychiatry)900 MAIN ST SUITE 400
PEORIA, IL 61602
(309) 672-3100
1205839883 BRADFORD EMIL COLEN MD
Individual
Psychiatry & Neurology (Psychiatry)900 MAIN ST STE 580
PEORIA, IL 61602
(309) 637-4266
1255374153MRS. ELIZABETH ANN ATCHASON MSN.FNP
Individual
Nurse Practitioner900 MAIN ST SUITE280
PEORIA, IL 61602
(309) 671-2570
1316066491 RITA BAILEY
Individual
Speech-Language Pathologist900 MAIN ST STE 450
PEORIA, IL 61602
(309) 672-4568
1386707354MRS. KELLY ANN ADCOCK BSN MSN APN
Individual
Nurse Practitioner (Acute Care)900 MAIN ST SUITE 320
PEORIA, IL 61602
(309) 672-3140
1487772448 MARY E GERIG P. T.
Individual
Physical Therapist900 MAIN ST SUITE 450
PEORIA, IL 61602
(309) 672-4569
1528075769 BALJIT SINGH MD
Individual
Psychiatry & Neurology (Psychiatry)900 MAIN ST SUITE 400
PEORIA, IL 61602
(309) 672-3100
1558480723 BARBARA DAILY ST
Individual
Speech-Language Pathologist900 MAIN ST STE 450
PEORIA, IL 61602
(309) 672-4568
1619981305 JIANMING DONG MD
Individual
Psychiatry & Neurology (Neurology)900 MAIN ST SUITE 250
PEORIA, IL 61602
(309) 672-4522
1669453114DR. BRIAN W HEYWOOD MD
Individual
Surgery900 MAIN ST SUITE 530
PEORIA, IL 61602
(309) 672-5975
1801802541 TSUNG HOWARD LIU MD
Individual
Psychiatry & Neurology (Neurology)900 MAIN ST SUITE 250
PEORIA, IL 61602
(309) 672-4522
1811058753 AUDREY A LEMASTERS LCSW
Individual
Social Worker (Clinical)900 MAIN ST SUITE 580
PEORIA, IL 61602
(309) 637-4266
1861490260DR. REID H. HANSEN M.D.
Individual
Surgery900 MAIN ST SUITE 500
PEORIA, IL 61602
(309) 637-3500
1891856795ASSOCIATES IN MENTAL HEALTH, SC
Organization
900 MAIN ST SUITE 580
PEORIA, IL 61602
(309) 637-4266
1932180387DR. WALTER SCOTT REID DO
Individual
Surgery900 MAIN ST SUITE 530
PEORIA, IL 61602
(309) 672-5975