Individual provider Active NPI

Richard Earl Johnson, PHD

  • Clinical Psychologist
  • Fort Worth, TX
National Provider Identifier
1306877527
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
25795 Issued in TX
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

Updated by the provider on May 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
1008109OtherUTAMERIGROUP
0077THOtherTXBCBS PROVIDER ID
102647805MedicaidTX
8B8909OtherTXBCBS
102647804MedicaidTX

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040108001080 TX Practitioner - Clinical Psychologist 7810897733 Reassigns benefits to 1 organization
Practice locations: Fort Worth, TX

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 100Reported as group
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

OrganizationSpecialtyStatusNew patients
Deer Oaks Geriatric Services P C Clinical CurrentSince May 1, 2008 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.

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

Verify at the official NPI Registry.