Active NPI
George 'Brick' Reter Johnstone, PHD
- Psychologist
- Columbia, MO
National Provider Identifier
1295788388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY004549
- Practice address
- 115 Business Loop 70 W
Columbia, MO 65203-3244 - Phone
- (573) 882-1561
- Fax
- (573) 884-1889
- NPI assigned
- May 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY004549 | GA | Primary |
| Clinical Psychologist | 103TC0700X | PYR0266 | MO |
Addresses
Primary practice location
115 Business Loop 70 W
Columbia, MO 65203-3244
Mailing address
2020 Peachtree Rd NW
Atlanta, GA 30309-1426
Phone (404) 367-1208
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 131610 | Other | MO | HEALTHLINK |
| 6145989 | Other | MO | UNITED HEALTHCARE |
| 680002939 | Other | MO | RR MEDICARE |
| 13644 | Other | MO | BLUE SHIELD/BLUE CHOICE |
| 493401103 | Medicaid | MO |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PYR0266 | MO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643846400000",
"number": "1295788388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2020 PEACHTREE RD NW",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303091426",
"telephone_number": "404-367-1208",
"fax_number": "404-603-4441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 BUSINESS LOOP 70 W",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652033244",
"telephone_number": "573-882-1561",
"fax_number": "573-884-1889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSTONE",
"first_name": "GEORGE",
"middle_name": "'BRICK' RETER",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-18",
"last_updated": "2022-02-03",
"certification_date": "2022-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "PSY004549",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MO",
"license": "PYR0266",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "131610",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "6145989",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "680002939",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD/BLUE CHOICE",
"identifier": "13644",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "493401103",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.