Individual provider Active NPI

Daniel E Johnson, PSYD

  • Psychologist
  • Colorado Springs, CO
National Provider Identifier
1083016513
Registry record updated Mar 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY0004355 Issued in CO
Practice address
1843 Austin Bluffs Pkwy
Colorado Springs, CO 80918-7857
Phone
(719) 291-9609
Fax
(866) 488-5608
NPI assigned
Sep 16, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY0004355 CO Primary

Addresses

Primary practice location

1843 Austin Bluffs Pkwy
Colorado Springs, CO 80918-7857

Mailing address

1843 Austin Bluffs Pkwy
Colorado Springs, CO 80918-7857
Phone (719) 291-9609

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20160115000809 CO Practitioner - Clinical Psychologist 5496058976 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2014
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1843 Austin Bluffs Pkwy
Colorado Springs, CO 80918-7857
Phone (719) 291-9609

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY0004355COMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Clear Skies Psychological Psychologist CurrentSince Mar 28, 2017 Accepting new patients

Locations

1843 Austin Bluffs Pkwy
Colorado Springs, CO 80918
Phone (719) 291-9609

3225 Templeton Gap Rd
Ste 214
Colorado Springs, CO 80907
Phone (719) 291-9609

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.

NPI Registry JSON

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

{
    "created_epoch": "1410825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553212800000",
    "number": "1083016513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1843 AUSTIN BLUFFS PKWY",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809187857",
            "telephone_number": "719-291-9609",
            "fax_number": "866-488-5608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1843 AUSTIN BLUFFS PKWY",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809187857",
            "telephone_number": "719-291-9609",
            "fax_number": "866-488-5608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DANIEL",
        "middle_name": "E",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-16",
        "last_updated": "2019-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "PSY0004355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.