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Deactivated NPI 1235133935 Deactivated / Inactive NPI Male Practitioner

Dr. David M Johnson , MD

Internal Medicine • Peoria, 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. David Johnson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date June 09, 2005
NPI Deactivation Date January 21, 2020
Total Practice Duration ~15 Years of Practice (2005 – 2020)

Professional Overview & Biography Verified Profile Summary

Dr. David Johnson, MD was a registered Internal Medicine practicing in Peoria, IL. Throughout an active medical career spanning 15 years, Dr. Johnson provided care at the practice location at 200 E PENNSYLVANIA AVE until profile deactivation on 2020-01-21.

Historical Medicare Part B clinical services included established patient outpatient office visit. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

200 E Pennsylvania Ave
Ste 105

Peoria, IL 616033045

Telephone 3096557888
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Internal Medicine in Peoria, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 17.5 Yrs
State Avg: 28.9 Yrs
Regional Practice Density
176 Specialists

Practicing in Peoria, IL (7544 Statewide)

Telehealth Adoption Rate
12.5% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
52.7% 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 (2017)
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes
12 12 $144.08 $68.11

Medical Specialties & State Licenses

Internal Medicine Primary Specialty

NUCC Taxonomy Code: 207R00000X

State License IL 036045095

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

5 Associated Practitioners
Dr. Dean Gravlin , MD

Internal Medicine

NPI 1053315861

Doctor of Medicine (M.D.)

Sharon Aycock , PA-C

Physician Assistant

NPI 1104813997

Physician Assistant (Certified)

Deena Raithel , APN

Nurse Practitioner

NPI 1508237744

Advanced Practice Nurse

Dr. Dennis Crnkovich , MD

Internal Medicine

NPI 1831164409

Doctor of Medicine (M.D.)

Dr. James Bauer , MD

Internal Medicine

NPI 1912901711

Doctor of Medicine (M.D.)

Career & Practice History Timeline

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

7 Historical Events
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NPI Profile Deactivated January 21, 2020

Record deactivated on January 21, 2020

NPI Profile Active September 13, 2012

NPI status registered as active in NPPES database

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Updated Practice Location September 13, 2012

Registered at 200 E PENNSYLVANIA AVE, STE 105, PEORIA, IL 616033045 (Tel: 3096557888)

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Updated Business Mailing Address September 13, 2012

Registered at 200 E PENNSYLVANIA AVE, STE 105, PEORIA, IL 616033045 (Tel: 3096557888)

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Provider Name / Credentials Updated September 13, 2012

Recorded as DAVID JOHNSON, M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) September 13, 2012

Internal Medicine (License #036045095 in IL)

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Initial NPI Registration & Enumeration June 09, 2005

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: 1235133935
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 09, 2005
Last Update: September 13, 2012
Deactivation Date: January 21, 2020

Mailing Address

200 E Pennsylvania Ave, Ste 105

Peoria, IL 616033045

Phone: 3096557888

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.