| Lewis Jeremy Johnson, DO | |
|
601 John St Ste M-318, Kalamazoo, MI 49007-5383 | |
| (269) 349-9745 | |
| (269) 488-8305 |
| Full Name | Lewis Jeremy Johnson |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Experience | 19 Years |
| Location | 601 John St Ste M-318, Kalamazoo, Michigan |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295979474 | NPI | - | NPPES |
| 300066454 | Medicaid | IN | |
| 1102384432 | Other | IN | ANTHEM PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | 5101017835 (Michigan) | Secondary |
| 208800000X | Urology | 3622 (Kentucky) | Secondary |
| 208800000X | Urology | 02006859A (Indiana) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Indiana University Health Ball Memorial Hospital | Muncie, IN | Hospital |
| Indiana University Health Jay, Inc. | Portland, IN | Hospital |
| Indiana University Health | Indianapolis, IN | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Iu Health Medical Group Llc | 9638617913 | 4320 |
| Indiana University Health Ball Memorial Physicians Inc | 9537072640 | 306 |
| Entity Name | Indiana University Health Ball Memorial Physicians Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1235455544 PECOS PAC ID: 9537072640 Enrollment ID: O20031110000505 |
| Mailing Address | Practice Location Address |
|---|---|
| Lewis Jeremy Johnson, DO 601 John St Ste M-318, Kalamazoo, MI 49007-5383 Ph: (269) 349-9745 | Lewis Jeremy Johnson, DO 601 John St Ste M-318, Kalamazoo, MI 49007-5383 Ph: (269) 349-9745 |
Dr. James B Bour, M.D. Urology Medicare: Medicare Enrolled Practice Location: 601 John St, Suite M206c, Kalamazoo, MI 49007 Phone: 269-349-9745 Fax: 269-488-8305 | |
Dr. Gregor W Blix, M.D. Urology Medicare: Medicare Enrolled Practice Location: 601 John St, Suite M206, Kalamazoo, MI 49007 Phone: 269-349-9745 Fax: 269-488-8305 | |
Dr. Mark A Lucas, M.D. Urology Medicare: Not Enrolled in Medicare Practice Location: 601 John St, Suite M-206c, Kalamazoo, MI 49007 Phone: 269-349-9745 Fax: 269-349-1013 | |
Pamela Sue Baron, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 601 John St, Ste M206c, Kalamazoo, MI 49007 Phone: 269-488-3230 Fax: 269-488-8305 | |
Austin Fernstrum, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 601 John St Ste M-318, Kalamazoo, MI 49007 Phone: 269-349-9745 | |
Dr. Robert R Isacksen, M.D. Urology Medicare: Medicare Enrolled Practice Location: 601 John St, Suite M206c, Kalamazoo, MI 49007 Phone: 269-349-9745 Fax: 269-488-8305 |