Active NPI
Richard Earl Johnson, PHD
- Clinical Psychologist
- Fort Worth, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 25795
- Practice address
- 3109 6TH Ave
Ste B
Fort Worth, TX 76110-3800 - Phone
- (817) 846-8466
- Fax
- (817) 288-0958
- NPI assigned
- Jul 5, 2006
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 25795 | TX | Primary |
Addresses
Primary practice location
3109 6TH Ave
Ste B
Fort Worth, TX 76110-3800
Mailing address
3109 6TH Ave Ste B
Fort Worth, TX 76110-3800
Phone (817) 846-8466
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1008109 | Other | UT | AMERIGROUP |
| 0077TH | Other | TX | BCBS PROVIDER ID |
| 102647805 | Medicaid | TX | |
| 8B8909 | Other | TX | BCBS |
| 102647804 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
3109 6TH Ave
Suite B
Fort Worth, TX 76110-3800
Phone (817) 846-8466
4220 Wells Dr
Fort Worth, TX 76135-2712
Phone (817) 237-6101
Merit-based Incentive Payment System (MIPS)
- Final score
- 91.17 of 100
- Quality
- 83.48
- Improvement activities
- 40
- Cost
- 67.52
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Deer Oaks Geriatric Services P C | Clinical | Current | Accepting new patients |
| Deer Oaks Mental Health Associates PC | Clinical | Past | Accepting new patients |
Locations
405 Duncan Perry Rd
Arlington, TX 76011
Phone (817) 649-3366
207 S Old Betsy Rd
Keene, TX 76059
Phone (817) 228-4855
413 Mansfield Cardinal Rd
#R
Kennedale, TX 76060
Phone (817) 645-8888
413 Mansfield Cardinal Rd
Kennedale, TX 76060
Phone (817) 561-4495
7272 Wurzbach Rd
Ste 706
San Antonio, TX 78240
Phone (210) 615-3401
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- San Antonio, TX
- NPI 1134169287
-
- Clinical Psychologist
- Las Cruces, NM
- NPI 1134175763
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714521600000",
"number": "1306877527",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3109 6TH AVE STE B",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761103800",
"telephone_number": "817-846-8466",
"fax_number": "817-288-0958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3109 6TH AVE",
"address_2": "STE B",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761103800",
"telephone_number": "817-846-8466",
"fax_number": "817-288-0958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "RICHARD",
"middle_name": "EARL",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-05",
"last_updated": "2024-05-01",
"certification_date": "2024-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "25795",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "1008109",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER ID",
"identifier": "0077TH",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102647805",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8B8909",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102647804",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.