Active NPI
Clark Johnsen, DO
- Psychiatry Physician
- New York, NY
National Provider Identifier
1306335450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 299739
- Practice address
- 67 Irving PL FL 6
New York, NY 10003-2237 - Phone
- (332) 334-7846
- NPI assigned
- May 4, 2018
- Last updated
- Mar 16, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 299739 | NY | Primary |
Addresses
Primary practice location
67 Irving PL FL 6
New York, NY 10003-2237
Mailing address
67 Irving PL FL 6
New York, NY 10003-2237
Phone (332) 334-7846
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 15, 2022 through Dec 15, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 299739 | NY | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678924800000",
"number": "1306335450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "67 IRVING PL FL 6",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100032237",
"telephone_number": "332-334-7846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "67 IRVING PL FL 6",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100032237",
"telephone_number": "332-334-7846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSEN",
"first_name": "CLARK",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-04",
"last_updated": "2023-03-16",
"certification_date": "2023-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "299739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.