Active NPI
Reilly Johnson, CADC-I
- Addiction (Substance Use Disorder) Counselor
- San Jose, CA
National Provider Identifier
1073973582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CI5201215
- Practice address
- 151 W Mission St
100
San Jose, CA 95110-1713 - Phone
- (408) 535-4002
- Fax
- (408) 280-7201
- NPI assigned
- Feb 25, 2016
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CI5201215 | CA | Primary |
Addresses
Primary practice location
151 W Mission St
100
San Jose, CA 95110-1713
Mailing address
151 W Mission St
100
San Jose, CA 95110-1713
Phone (408) 535-4002
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CI5201215 | Other | CA | CCAPP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CI5201215 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456358400000",
"number": "1073973582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 W MISSION ST",
"address_2": "100",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951101713",
"telephone_number": "408-535-4002",
"fax_number": "408-280-7201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 W MISSION ST",
"address_2": "100",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951101713",
"telephone_number": "408-535-4002",
"fax_number": "408-280-7201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "REILLY",
"credential": "CADC-I",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-02-25",
"last_updated": "2016-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "CI5201215",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CCAPP",
"identifier": "CI5201215",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.