Active NPI
John Wood Fishburne IV, PH.D.
- Psychologist
- Spokane, WA
National Provider Identifier
1003957291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY00003685
- Practice address
- 104 S Freya St Ste 214a
Spokane, WA 99202-6204 - Phone
- (509) 888-0048
- Fax
- (509) 534-3193
- NPI assigned
- Feb 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY00003685 | WA | Primary |
Addresses
Primary practice location
104 S Freya St Ste 214a
Spokane, WA 99202-6204
Mailing address
104 S Freya St Ste 214a
Spokane, WA 99202-6204
Phone (509) 888-0048
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
104 S Freya St
214A
Spokane, WA 99202-6204
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Philosophy
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Wenatchee, WA
- NPI 1669864047
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541635200000",
"number": "1003957291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 S FREYA ST STE 214A",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992026204",
"telephone_number": "509-888-0048"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 S FREYA ST STE 214A",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992026204",
"telephone_number": "509-888-0048",
"fax_number": "509-534-3193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISHBURNE",
"first_name": "JOHN",
"middle_name": "WOOD",
"name_prefix": "Dr.",
"name_suffix": "IV",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-09",
"last_updated": "2018-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WA",
"license": "PY00003685",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.