Active NPI
David Michael Johnson, PSYD
- Psychologist
- Greenfield, MA
National Provider Identifier
1104977016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1177
- Practice address
- 16 Federal St
Greenfield, MA 01301-3302 - Phone
- (413) 772-0144
- Fax
- (413) 772-0413
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1177 | MA | Primary |
Addresses
Primary practice location
16 Federal St
Greenfield, MA 01301-3302
Mailing address
16 Federal St
Greenfield, MA 01301-3302
Phone (413) 772-0144
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005919094 | Other | MA | AETNA |
| 0504173 | Medicaid | MA | |
| W01676 | Other | MA | BLUE CROSS & BLUE SHIELD |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1177 | MA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104977016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 FEDERAL ST",
"city": "GREENFIELD",
"state": "MA",
"postal_code": "013013302",
"telephone_number": "413-772-0144",
"fax_number": "413-772-0413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16 FEDERAL ST",
"city": "GREENFIELD",
"state": "MA",
"postal_code": "013013302",
"telephone_number": "413-772-0144",
"fax_number": "413-772-0413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "DAVID",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "1177",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0005919094",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0504173",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS & BLUE SHIELD",
"identifier": "W01676",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenfield, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.