Stacy Kim Johnston, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY17457 Issued in CA

Practice address

4730 Palm Ave
202
La Mesa, CA 91941-5266

Phone

(619) 778-7215

Fax

(619) 328-9332

NPI assigned

Jan 4, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Pacific Psychology Centers, ApcGroup PAC ID 8022334200, 2 clinicians

Southern California Psychology Centers ApcGroup PAC ID 6406170653, 23 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• Pacific Psychology Centers, Apc.

  • Clinical Psychologist
  • Carlsbad, CA
  • NPI 1295124998
  Medicare reassignment Care Compare group NPD
• Southern California Psychology Centers, Apc

  dba San Diego Psychology & Assessment Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Diego, CA
  • NPI 1386066363
  Medicare reassignment Care Compare group NPD
• Stacy Kim Johnston Psychology, Inc.

  • Clinical Psychologist
  • San Diego, CA
  • NPI 1316554322
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376870400000",
    "number": "1063569135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4730 PALM AVE STE 202",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919415244",
            "telephone_number": "619-778-7215",
            "fax_number": "619-328-9332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 PALM AVE",
            "address_2": "202",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919415266",
            "telephone_number": "619-778-7215",
            "fax_number": "619-328-9332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "STACY",
        "middle_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2013-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY17457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mattison Brooke Johnson I, LVN
• Nancy Denise Johnson, MFT
• Peter Fink Johnson, D.M.D.
• Ronald M Johnson, MD
• Shevanthi Rebekah Johnson, DDS
• Joie de Vivre Acupuncture
• Helene Sy Jolly, PA-C
• Jon J Roth MD Inc
• Britta Jean Jones
• Isabel Jones, PT, DPT, ATC

• Clinical Psychologist in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2013; 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.

Verify at the official NPI Registry.