Theodore Johnson, MD
NPI 1609523240ActiveIndividual· General Practice· Great Lakes, IL
General Practice (MD) in Great Lakes, Illinois, licensed in VA, with an NPI issued in March 2022.
Overview
| NPI | 1609523240 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | MD |
| Sole proprietor | No |
| NPI issued | Mar 3, 2022 |
| Last updated in NPPES | Jul 9, 2025 |
| Certified by provider | Jul 9, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| General Practice Primary | 208D00000X | 0101279593 | VA |
| Military Health Care Provider | 171000000X | 0101279593 | VA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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