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Deactivated NPI 1205816105 Deactivated / Inactive NPI Male Practitioner

Dr. Randy Johnson , MD

Internal Medicine • Millstadt, IL

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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. Randy Johnson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date January 18, 2006
NPI Deactivation Date May 31, 2019
Total Practice Duration ~13 Years of Practice (2006 – 2019)

Professional Overview & Biography Verified Profile Summary

Dr. Randy Johnson, MD was a registered Internal Medicine practicing in Millstadt, IL. Throughout an active medical career spanning 13 years, Dr. Johnson provided care at the practice location at 60 REGENCY PL until profile deactivation on 2019-05-31.

Historical Medicare Part B clinical services included routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only, ultrasound of heart with color-depicted blood flow, rate, direction and valve function, subsequent hospital care with moderate levelof medical decision making, if using time, at least. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

60 Regency Pl

Millstadt, IL 622602210

Telephone 6184763373
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Internal Medicine in Millstadt, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 21.0 Yrs
State Avg: 28.9 Yrs
Regional Practice Density
2 Specialists

Practicing in Millstadt, IL (7544 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
86.5% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2018)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
93010 Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only
325 246 $26.00 $8.36
93306 Ultrasound of heart with color-depicted blood flow, rate, direction and valve function
35 35 $569.00 $71.82

Medical Specialties & State Licenses

Internal Medicine Primary Specialty

NUCC Taxonomy Code: 207R00000X

State License IL 036-061540

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Practice Associates & Co-Workers

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

4 Associated Practitioners
Dr. Carla Samson , MD

Family Medicine

NPI 1316944986

Doctor of Medicine (M.D.)

NPI 1326056540

Doctor of Medicine (M.D.)

Dr. Erin Friedman , DO

Internal Medicine

NPI 1356557698

Doctor of Osteopathic Medicine (D.O.)

Mary Hollenkamp , APN

Nurse Practitioner - Family

NPI 1649241951

Advanced Practice Nurse

Career & Practice History Timeline

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

17 Historical Events
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NPI Profile Deactivated May 31, 2019

Record deactivated on May 31, 2019

NPI Profile Active March 17, 2018

NPI status registered as active in NPPES database

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Updated Practice Location March 17, 2018

Registered at 2071 GOOSE LAKE RD, SAUGET, IL 622062822 (Tel: 6188572702)

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Updated Business Mailing Address March 17, 2018

Registered at 2071 GOOSE LAKE RD, SAUGET, IL 622062822 (Tel: 6188572702)

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Provider Name / Credentials Updated March 17, 2018

Recorded as RANDY JOHNSON, MD

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Medical Taxonomy / Specialty Registered (Primary Specialty) March 17, 2018

Internal Medicine (License #036-061540 in IL)

NPI Profile Active October 19, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location October 19, 2017

Registered at 2071 GOOSE LAKE RD, SAUGET, IL 622062822 (Tel: 6188572702)

📍
Updated Business Mailing Address October 19, 2017

Registered at 2071 GOOSE LAKE RD, SAUGET, IL 622062822 (Tel: 6188572702)

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Provider Name / Credentials Updated October 19, 2017

Recorded as RANDY JOHNSON, MD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 19, 2017

Internal Medicine (License #036-061540 in IL)

NPI Profile Active March 31, 2015

NPI status registered as active in NPPES database

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Updated Practice Location March 31, 2015

Registered at 60 REGENCY PL, MILLSTADT, IL 622602210 (Tel: 6184763373)

📍
Updated Business Mailing Address March 31, 2015

Registered at 60 REGENCY PL, MILLSTADT, IL 622602210 (Tel: 6184763373)

👤
Provider Name / Credentials Updated March 31, 2015

Recorded as RANDY JOHNSON, MD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 31, 2015

Internal Medicine (License #036-061540 in IL)

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Initial NPI Registration & Enumeration January 18, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1205816105
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 18, 2006
Last Update: March 31, 2015
Deactivation Date: May 31, 2019

Mailing Address

60 Regency Pl

Millstadt, IL 622602210

Phone: 6184763373

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.