Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1780615179 Deactivated / Inactive NPI Male Practitioner

Dr. Kent Edward Johnson , MD

Urology • Marion, IL

⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Kent Johnson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 05, 2006
NPI Deactivation Date February 08, 2017
Total Practice Duration ~11 Years of Practice (2006 – 2017)

Professional Overview & Biography Verified Profile Summary

Dr. Kent Johnson, MD was a registered Urology practicing in Marion, IL. Throughout an active medical career spanning 11 years, Dr. Johnson provided care at the practice location at 2401 W MAIN ST until profile deactivation on 2017-02-08.

Practice Location & Contact Primary Location

Practice Address

2401 W Main St

Marion, IL 629591188

Telephone 6189985603
Fax 6189985685
Associated Practice Facility / Clinic
🏢 St. Louis Jc Vamc Facility NPI 1750349429

Specialty Benchmarks & Practice Insights

Comparative analytics for Urology in Marion, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 29.0 Yrs
State Avg: 26.7 Yrs
Regional Practice Density
6 Specialists

Practicing in Marion, IL (663 Statewide)

Telehealth Adoption Rate
16.7% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Urology Primary Specialty

NUCC Taxonomy Code: 208800000X

State License CO 22270

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.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Michele Otto , RN

Registered Nurse

NPI 1003515420

Registered Nurse

Aaron Ruzich

Physical Therapy Assistant

NPI 1003670548
NPI 1003672486

REGISTEREDNURSE

Ray Bayer , OTR, L

Occupational Therapist

NPI 1003822917

Occupational Therapist Registered, L

NPI 1013511922

Master of Science, Doctor of Philosophy (Ph.D.), Registered Dietitian, Registered Dietitian Nutritionist

Tameeka Marvin

Registered Nurse

NPI 1013613397

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
⚠️
NPI Profile Deactivated February 08, 2017

Record deactivated on February 08, 2017

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2007

Registered at 2401 W MAIN ST, MARION, IL 629591188 (Tel: 6189985603)

📍
Updated Business Mailing Address July 08, 2007

Registered at 630 B LUXOR LANDING RD., GOREVILLE, IL 62939 (Tel: 6189951238)

👤
Provider Name / Credentials Updated July 08, 2007

Recorded as KENT JOHNSON, M.D.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Urology (License #22270 in CO)

🟢
Initial NPI Registration & Enumeration July 05, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews
No patient reviews submitted yet for Dr. Kent Johnson. Be the first to share your experience!

Sign in to leave a review for Dr. Kent Johnson

Only verified registered users can submit ratings, post feedback, and upload facility photos.

NPI Administrative Meta

NPI Number: 1780615179
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 05, 2006
Last Update: July 08, 2007
Deactivation Date: February 08, 2017

Mailing Address

630 B Luxor Landing Rd.

Goreville, IL 62939

Phone: 6189951238

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.