Dr Matthew Todd Johnson, MD is a medicare enrolled "Family Medicine" physician in Park Forest, Illinois. His current practice location is
344 Victory Dr, Park Forest, Illinois. You can reach out to his office (for appointments etc.) via phone at
(708) 481-0100.
Dr Matthew Todd Johnson is licensed to practice in Illinois (license number 036099289) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1568643864.
Physician's Profile
| Full Name | Dr Matthew Todd Johnson |
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| Gender | Male |
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| Speciality | Family Medicine |
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| Location | 344 Victory Dr, Park Forest, Illinois |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1568643864
- Provider Enumeration Date: 11/15/2007
- Last Update Date: 05/04/2018
Medicare PECOS Information:
- PECOS PAC ID: 1850374026
- Enrollment ID: I20040609000708
Medical Identifiers
Medical identifiers for Dr Matthew Todd Johnson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1568643864 | NPI | - | NPPES |
| 036099289 | Medicaid | IL | |
| 01634105 | Other | IL | BLUE CROSS PROVIDER # |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207Q00000X | Family Medicine | 036099289 (Illinois) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Matthew Todd Johnson allows following entities to bill medicare on his behalf.
| Entity Name | The Board Of Trustees Of The University Of Illinois |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1386863819
PECOS PAC ID: 3072422716
Enrollment ID: O20031112000158 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Matthew Todd Johnson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Matthew Todd Johnson, MD
111 Acacia Dr, Unit 515,
Indian Head Park, IL 60525-4404
Ph: (708) 481-0100 | Dr Matthew Todd Johnson, MD
344 Victory Dr,
Park Forest, IL 60466-2003
Ph: (708) 481-0100 |
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