Active NPI
John Wesley Addis, PHD
- Psychologist
- Bradford, PA
National Provider Identifier
1306028105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS002352L
- Practice address
- 23 Kennedy Street
Suite 202
Bradford, PA 16701-2005 - Phone
- (814) 362-2136
- Fax
- (814) 362-2136
- NPI assigned
- Dec 4, 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 | PS002352L | PA | Primary |
Addresses
Primary practice location
23 Kennedy Street
Suite 202
Bradford, PA 16701-2005
Mailing address
23 Kennedy Street
Suite 202
Bradford, PA 16701-2005
Phone (814) 362-2136
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6803636 | Other | PA | VALUE OPTIONS |
| 0004277250 | Other | PA | AETNA |
| 000507570001 | Other | NY | BCBS OF WNY |
| 1415000 | Other | PA | MEGALLAN |
| P009953 | Other | PA | TRICARE |
| 00050141001 | Other | PA | HMO |
| 031013 | Other | PA | BCBS |
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 |
|---|---|---|---|
| PS002352L | PA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196726400000",
"number": "1306028105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 KENNEDY STREET",
"address_2": "SUITE 202",
"city": "BRADFORD",
"state": "PA",
"postal_code": "167012005",
"telephone_number": "814-362-2136",
"fax_number": "814-362-2468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 KENNEDY STREET",
"address_2": "SUITE 202",
"city": "BRADFORD",
"state": "PA",
"postal_code": "167012005",
"telephone_number": "814-362-2136",
"fax_number": "814-362-2136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ADDIS",
"first_name": "JOHN",
"middle_name": "WESLEY",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-04",
"last_updated": "2007-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS002352L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "6803636",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0004277250",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF WNY",
"identifier": "000507570001",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEGALLAN",
"identifier": "1415000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "P009953",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMO",
"identifier": "00050141001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "031013",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bradford, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.