BERNARD JOHNSON (NPI# 1730198961) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730198961 |
| Entity Type | Individual |
| Full Name | BERNARD JOHNSON |
| Credential | M.D. |
| Practice Address |
1850 Gateway Dr Sycamore IL 60178-3192 |
| Practice Telephone | 8157588671 |
| Mailing Telephone | 8157588671 |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2012-05-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 036-048439 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | HEALTH ALLIANCE | 008456 | 01 |
| IL | 036048439 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346453693 | Bernard A Johnson | Dentist | 6501 Greenfield Rd, #201, Detroit, MI 48228-4780 | 2007-05-07 |
| 1386625341 | Bernard Joseph Johnson | Dentist | 4368 Dressler Rd Nw, Canton, OH 44718-2771 | 2005-11-08 |
| 1124508676 | Bernard Johnson | Counselor | 6753 State Rd, Parma, OH 44134-4517 | 2018-08-15 |
| Street Address |
1850 GATEWAY DR |
| City | SYCAMORE |
| State | IL |
| Zip Code | 60178-3192 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023018322 | Asra F Khan | Family Medicine | 1850 Gateway Dr, Sycamore, IL 60178-3192 | 2005-07-28 |
| 1528601127 | Michelle L Gosnell | Nurse Practitioner | 1850 Gateway Dr, Sycamore, IL 60178-3192 | 2019-10-26 |
| 1568016335 | Andi Marie Rivers | Nurse Practitioner | 1850 Gateway Dr, Sycamore, IL 60178-3192 | 2019-07-30 |
| 1457815938 | Jessica Moede | Nurse Practitioner | 1850 Gateway Dr, Sycamore, IL 60178-3192 | 2019-01-29 |
| 1265903447 | Kimberly J Aldis | Registered Nurse | 1850 Gateway Dr, Sycamore, IL 60178-3192 | 2018-12-16 |
| 1114401833 | Jennifer Tarvestad | Nurse Practitioner | 1850 Gateway Dr, Sycamore, IL 60178-3192 | 2018-09-18 |
| 1518456003 | Keelin Willits | Urology | 1850 Gateway Dr, Sycamore, IL 60178-3192 | 2018-05-09 |
| 1255853859 | Ricardo Manuel De Oliveira Soares | Urology | 1850 Gateway Dr, Sycamore, IL 60178-3192 | 2017-07-14 |
| 1174067227 | Jamie Gibson | Nurse Practitioner | 1850 Gateway Dr, Sycamore, IL 60178-3192 | 2016-12-08 |
| 1679933139 | Kishwaukee Physician Group, Inc. | Durable Medical Equipment & Medical Supplies | 1850 Gateway Dr, Sycamore, IL 60178-3192 | 2016-02-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578113387 | Susanne Dewey | Technician | 2158 W. Vance St., Sycamore, IL 60178 | 2019-09-13 |
| 1730745332 | Nan Chinratana Phillips | Registered Nurse | 427 Spartan Trail Shs Nurse Office, Sycamore, IL 60178 | 2019-05-20 |
| 1427517846 | Association for Individual Development | Clinic/Center | 180 E. Exchange St., #202a, Sycamore, IL 60178 | 2019-03-15 |
| 1528508884 | Mary Elizabeth Kelley | Counselor | 920 S Prairie Dr., F, Sycamore, IL 60178 | 2017-03-06 |
| 1366824005 | Dekalb Hearing Services, LLC | Audiologist | 1630 Gateway Drive, Sycamore, IL 60178 | 2015-06-18 |
| 1629458625 | Friedrichs Eye Ltd. | Ophthalmology | 2670 Dekalb Avenue, Sycamore, IL 60178 | 2015-06-04 |
| 1275912057 | Sara Haug | Counselor | 324 E. Exchange St, Sycamore, IL 60178 | 2015-05-26 |
| 1144607862 | Dekalb Surgical Services, LLC | Clinic/Center | 2515 Klein Road, Sycamore, IL 60178 | 2015-05-01 |
| 1720476963 | Jennifer Calderala | Registered Nurse | 165 E. Plank Road, Sycamore, IL 60178 | 2014-12-22 |
| 1114262656 | Teresa Kay Farris | Nurse Practitioner | 1850 Gateway Drive, Sycamore, IL 60178 | 2012-12-11 |
| Find all providers in zip 60178 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518456003 | Keelin Willits | Urology | 1850 Gateway Dr, Sycamore, IL 60178-3192 | 2018-05-09 |
| 1255853859 | Ricardo Manuel De Oliveira Soares | Urology | 1850 Gateway Dr, Sycamore, IL 60178-3192 | 2017-07-14 |
| 1699784827 | Jay Burstein | Urology | 1850 Gateway Dr, Sycamore, IL 60178-3192 | 2006-08-05 |
| 1467488957 | Sajit Bux | Urology | 1850 Gateway Dr, Sycamore, IL 60178-3192 | 2006-06-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699236612 | Behdod Katebian | Urology | 5841 S Maryland Ave Rm J-653, Chicago, IL 60637-1443 | 2019-03-31 |
| 1912436015 | Robert Ara Petrossian | Urology | 301 N 8th St # 4b143c, Springfield, IL 62701-1041 | 2017-06-12 |
| 1134657026 | Soojin Kim | Urology | 225 E. Chicago Avenue, Box 24, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611 | 2017-05-23 |
| 1619337912 | George Robert Buckun | Urology | 930 Rogers St., #301, Downers Grove, IL 60515 | 2016-02-29 |
| 1275991606 | Nicole Alyssa Hamilton | Urology | 22285 N Pepper Rd Ste 201, Lake Barrington, IL 60010-2540 | 2016-01-30 |
| 1790164002 | Shay Golan | Urology | 5841 S Maryland Ave Mc6038, Chicago, IL 60637-1447 | 2015-05-20 |
| 1528453594 | Christopher Stockdale | Urology | 300 W Hill St Apt 707, Chicago, IL 60610-7537 | 2015-04-06 |
| 1639568447 | Jeremy Lai | Urology | 420 E Superior St Ste 9-900, Chicago, IL 60611-4494 | 2015-01-16 |
| 1386053759 | Ramiro Felix Prudencio | Urology | 1200 Broadmeadow Rd, Winnetka, IL 60093-3707 | 2014-08-10 |
| 1174933048 | Kyle John Ericson | Urology | 924 E 57th St, Suite 104, Chicago, IL 60637-1455 | 2014-05-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.