Individual provider Active NPI

Breanna Jo Johnson, BA CADC

  • Clinical Social Worker
  • Mason City, IA
National Provider Identifier
1063847473
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
107714 Issued in IA
Practice address
320 N Eisenhower Ave
Mason City, IA 50402-1338
Phone
(641) 424-2391
Fax
(641) 424-0783
NPI assigned
Sep 5, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 107714 IA Primary

Addresses

Primary practice location

320 N Eisenhower Ave
Mason City, IA 50402-1338

Mailing address

PO Box 1338
320 N Eisenhower Ave
Mason City, IA 50402-1338
Phone (641) 424-2391

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20240318001860 IA Practitioner - Clinical Social Worker 5597102228 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

320 N Eisenhower Ave
Mason City, IA 50401-1521
Phone (641) 424-2391

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Arts

State licenses

LicenseStateTypeSpecialty
107714IAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Prairie Ridge Integrated Behavioral Healthcare CurrentSince Feb 22, 2024 Accepting new patients
Prairie Ridge Integrated Behavioral Healthcare Addiction (Substance Use Disorder) CurrentSince Feb 22, 2024 Accepting new patients
Prairie Ridge Integrated Behavioral Healthcare Past Accepting new patients

Locations

320 N Eisenhower Ave
Mason City, IA 50401
Phone (641) 423-1481

Organizations & group practices 3

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": "1378339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708992000000",
    "number": "1063847473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1338",
            "address_2": "320 N EISENHOWER AVE",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504021338",
            "telephone_number": "641-424-2391",
            "fax_number": "641-424-0783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 N EISENHOWER AVE",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504021338",
            "telephone_number": "641-424-2391",
            "fax_number": "641-424-0783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BREANNA",
        "middle_name": "JO",
        "name_prefix": "Mrs.",
        "credential": "BA CADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-05",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "107714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mason City, IA

Sources for this page

Verify at the official NPI Registry.