Individual provider Active NPI

Erica N Johnson

  • Psychiatric/Mental Health Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1124618335
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
SP023058 Issued in PA
Practice address
1015 Chestnut St Ste 1520
Philadelphia, PA 19107-4315
Phone
(484) 246-6416
NPI assigned
Jan 21, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X SP023058 PA Primary

Addresses

Primary practice location

1015 Chestnut St Ste 1520
Philadelphia, PA 19107-4315

Mailing address

1015 Chestnut St Ste 1520
Philadelphia, PA 19107-4315
Phone (484) 358-0331

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210507000009 PA Practitioner - Nurse Practitioner 5092124883 Reassigns benefits to 2 organizations
I20220831002206 NY Practitioner - Nurse Practitioner 5092124883 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thrive Counseling LLCGroup PAC ID 0749458420, 1,187 clinicians

Practice addresses (Care Compare)

1015 Chestnut St
Suite 403
Philadelphia, PA 19107-4304
Phone (855) 284-7483

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP023058PAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Counseling LLC CurrentSince Apr 21, 2021 Accepting new patients
Medical Director Services PC CurrentSince May 19, 2022 Accepting new patients
Vital Healthcare Solutions CurrentSince May 1, 2021 Accepting new patients

Locations

50 Sheffield Ave
Brooklyn, NY 11207
Phone (718) 250-8789

1311 Virginia St
Far Rockaway, NY 11691
Phone (718) 327-2908

1015 Chestnut St
Ste 1520
Philadelphia, PA 19107
Phone (215) 601-7379

1015 Chestnut St
Ste 403
Philadelphia, PA 19107
Phone (215) 625-9770

5830 Ellsworth Ave
Ste 301
Pittsburgh, PA 15232
Phone (412) 208-6279

2395 Lancaster Pike
Fl 1
Reading, PA 19607
Phone (570) 561-2990

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": "1611187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1124618335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 CHESTNUT ST STE 1520",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074315",
            "telephone_number": "484-358-0331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 CHESTNUT ST STE 1520",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074315",
            "telephone_number": "484-246-6416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ERICA",
        "middle_name": "N",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-21",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP023058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.