Dr. Theodore Johnson , MD
General Practice β’ Great Lakes, IL
3410 Illinois St
Great Lakes, IL 600883120
This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.
Practice Location & Contact Primary Location
3410 Illinois St
Great Lakes, IL 600883120
What Public CMS Data Show
General Practice: NPPES taxonomy is a reported classification, not proof of board certification.
Industry payments (Open Payments)
No Open Payments records are listed for this clinician for 2019β2025.
NPI first issued
2022
The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.
What this does not show: NPI first issued
NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.
Source: CMS NPPES NPI Registry.
Medicare assignment not listed
CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.
Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.
Source: CMS Doctors and Clinicians; Medicare.gov, βDoes your provider accept Medicare as full payment?β
No telehealth indicator
CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.
Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.
Compared with the same specialty in Great Lakes and Illinois
6 active clinicians are listed under General Practice with a practice address in Great Lakes, IL (291 in Illinois).
Addresses are self-reported to NPPES and may be out of date.
Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.
Text: T-MedInfo Β· Report an error.
Specialties & License Numbers Reported to NPPES
Self-certified to NPPES: 2025-07-09NUCC Taxonomy Code: 208D00000X
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
NUCC Taxonomy Code: 171000000X
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
Clinicians Sharing This Practice Address or Phone
Clinicians sharing this NPPES address, phone or fax; a shared contact does not mean they work together.
Physician Assistant
Physician Assistant (Certified)
Career & Practice History Timeline
Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status
Registered at 3410 ILLINOIS ST, GREAT LAKES, IL 600883120 (Tel: 2246108553)
Registered at 220 HOVEY RD, PENSACOLA, FL 325081044 (Tel: 7033958196)
Registered at 220 HOVEY RD, PENSACOLA, FL 325081044
Recorded as THEODORE JOHNSON, MD
Military Health Care Provider (license number reported to NPPES: VA 0101279593)
NPI status registered as active in NPPES database
Registered at 9040 JACKSON AVE, TACOMA, WA 984310001 (Tel: 2539680117)
Registered at 9040 JACKSON AVE, TACOMA, WA 984310001 (Tel: 2539680117)
Recorded as THEODORE JOHNSON
Student in an Organized Health Care Education/Training Program
First registered as active Individual Practitioner in NPPES Database.
NPI Administrative Meta
Mailing Address
220 Hovey Rd
Pensacola, FL 325081044