Kevin Johnson, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301019443 Issued in MI

Practice address

363 W Big Beaver Rd Ste 400
Troy, MI 48084-5242

Phone

(248) 509-7657

NPI assigned

Mar 11, 2024

Last updated

Mar 11, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Clinical Psychologist

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

McLaren Port HuronGroup PAC ID 9931018702, 48 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• McLaren Port Huron Hospital, Port Huron, MI, CCN 230216

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• McLaren Port Huron

  dba Port Huron Hospital Physician GRP

  • Psychiatry Physician
  • Port Huron, MI
  • NPI 1386888170
  Medicare reassignment Care Compare group NPD
• Nexus Behavioral Health PLLC

  • Clinical Psychologist
  • Troy, MI
  • NPI 1477066140
  Medicare reassignment NPD
• Blue Water OB & GYN PC

  • Obstetrics & Gynecology Physician
  • Port Huron, MI
  • NPI 1508954603
  NPD
• McLaren Port Huron

  • Family Medicine Physician
  • Port Huron, MI
  • NPI 1619355930
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• McLaren Port Huron

  • General Acute Care Hospital
  • Port Huron, MI
  • NPI 1982685384
  Care Compare affiliation

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

{
    "created_epoch": "1710115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1255199774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "363 W BIG BEAVER RD STE 400",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480845242",
            "telephone_number": "810-300-3178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 W BIG BEAVER RD STE 400",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480845242",
            "telephone_number": "248-509-7657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-03-11",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301019443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Janice L Johnson, MD
• Jasmine Johnson
• Joyce Agnes Johnson, RPH
• Kenneth R Johnson, RPH
• Allyson Ann Johnston
• Join Acupuncture and Herbal Medicine in Mi
• J Mark Joliat, MD
• Jonathan Michael Joliat, M.D.
• Thomas L Joliat, MD

• Psychologist in Troy, MI
• Providers in Troy, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.