Midlands Psychological Associates, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

MIDLANDS PSYCHOLOGICAL ASSOCIATES, LLC

Practice address

336 Lodi St
Lodi, WI 53555-1418

Phone

(608) 592-2080

Fax

(608) 592-7120

NPI assigned

Jun 12, 2006

Last updated

Mar 18, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ronald Bruce Johnson, PHDNPI 1598701906

Title

Owner/Partner

Phone

(608) 592-2080

Specialties & licenses 1

Addresses

Other names 1

• Midlands Pschological Associates Former legal business name

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ronald Bruce Johnson, PHD

  • Clinical Psychologist
  • Lodi, WI
  • NPI 1598701906
  Medicare reassignment NPD Authorized official
• Deborah Lynn Brock, PHD

  • Professional Counselor
  • Lodi, WI
  • NPI 1679519953
  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363564800000",
    "number": "1285676593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "336 LODI ST",
            "city": "LODI",
            "state": "WI",
            "postal_code": "535551418",
            "telephone_number": "608-592-2080",
            "fax_number": "608-592-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 LODI ST",
            "city": "LODI",
            "state": "WI",
            "postal_code": "535551418",
            "telephone_number": "608-592-2080",
            "fax_number": "608-592-7120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDLANDS PSYCHOLOGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2013-03-18",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "608-592-2080",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midlands Pschological Associates",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Becky Marie Patterson, RN

• Clinical Psychologist in Lodi, WI
• Providers in Lodi, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.