NPIMap

Individual provider Active NPI

Pamela Penina Johnson, CRNP-PMH

  • Psychiatric/Mental Health Nurse Practitioner
  • Baltimore, MD
National Provider Identifier
1023252129
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
R172158 Issued in MD
Practice address
17 Warren Rd Ste 20B
Baltimore, MD 21208-5334
Phone
(410) 484-0036
Fax
(410) 484-8107
NPI assigned
Apr 21, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X R172158 MD Primary

Addresses

Primary practice location

17 Warren Rd Ste 20B
Baltimore, MD 21208-5334

Mailing address

17 Warren Rd Ste 20B
Baltimore, MD 21208-5334
Phone (410) 484-0036

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180524000065 MD Practitioner - Nurse Practitioner 8224320189 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R172158MDMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Citywide Community Resources Corporation Current Accepting new patients
Citywide Behavioral Health Current Accepting new patients
Citywide Behavioral Health Psychiatric/Mental Health Past Accepting new patients
Citywide Health Corporation Psychiatric/Mental Health Past Accepting new patients
Citywide Behavioral Health PastSince Feb 21, 2021 Accepting new patients
Citywide Behavioral Health Psychiatric/Mental Health Past Accepting new patients
Citywide Behavioral Health Past Accepting new patients
Citywide Behavioral Health Past Accepting new patients
Citywide Behavioral Health Past Accepting new patients
Citywide Behavioral Health Past Accepting new patients
Citywide Behavioral Health PastSince Nov 15, 2020 Accepting new patients

Locations

17 Warren Rd
Ste 20B
Pikesville, MD 21208
Phone (410) 484-0036

Organizations & group practices 12

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1023252129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 WARREN RD STE 20B",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212085334",
            "telephone_number": "410-484-0036",
            "fax_number": "410-484-8107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 WARREN RD STE 20B",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212085334",
            "telephone_number": "410-484-0036",
            "fax_number": "410-484-8107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "PAMELA",
        "middle_name": "PENINA",
        "credential": "CRNP-PMH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-21",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R172158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.