Active NPI
Michael T Johnson
- Behavior Analyst
- Philadelphia, PA
National Provider Identifier
1336903368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- BH006627
- Practice address
- 1165 S Broad St FL 3
Philadelphia, PA 19147-4433 - Phone
- (484) 393-4107
- Fax
- (484) 231-8631
- NPI assigned
- Feb 9, 2024
- 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 |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | BH006627 | PA | Primary |
Addresses
Primary practice location
1165 S Broad St FL 3
Philadelphia, PA 19147-4433
Mailing address
640 Freedom Business Ctr Dr Ste 220
King of Prussia, PA 19406-1376
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BH006627 | PA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707436800000",
"number": "1336903368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "640 FREEDOM BUSINESS CTR DR STE 220",
"city": "KING OF PRUSSIA",
"state": "PA",
"postal_code": "194061376"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1165 S BROAD ST FL 3",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191474433",
"telephone_number": "484-393-4107",
"fax_number": "484-231-8631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "MICHAEL",
"middle_name": "T",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-02-09",
"last_updated": "2024-02-09",
"certification_date": "2024-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "PA",
"license": "BH006627",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.