Individual provider Active NPI

Joseph Hilliard Johnson, PHD

  • Clinical Psychologist
  • Beaverton, OR
National Provider Identifier
1356411763
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1024 Issued in OR
Practice address
9670 SW Beaverton Hillsdale Hwy
Beaverton, OR 97005
Phone
(503) 626-9494
Fax
(503) 646-8401
NPI assigned
Nov 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 1024 OR Primary

Addresses

Primary practice location

9670 SW Beaverton Hillsdale Hwy
Beaverton, OR 97005

Mailing address

PO Box 82819
Portland, OR 97282
Phone (503) 233-5405

Other identifiers 1

IdentifierTypeStateIssuer
164936MedicaidOR

Other names 1

  • Jay Hilliard Johnson Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20200130001566 OR Practitioner - Clinical Psychologist 8426484064 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

880 82ND Dr
Gladstone, OR 97027-1803
Phone (503) 659-5515

890 82ND Dr
Gladstone, OR 97027-1803
Phone (503) 659-5515

890 SE
82ND
Gladstone, OR 97027-1803
Phone (503) 659-5515

9600 SW Oak St
Suite 500And520
Tigard, OR 97223-6583
Phone (971) 364-8069

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
1024ORMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Western Psychological and Counseling Services LLC Clinical CurrentSince Nov 3, 2019 Accepting new patients
Western Psychological and Counseling Services LLC Clinical CurrentSince Nov 3, 2019 Accepting new patients

Locations

9670 SW Beaverton Hillsdale Hwy
Beaverton, OR 97005
Phone (503) 626-9494

880 82nd Dr
Gladstone, OR 97027
Phone (503) 626-9494

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.josephjohnson@148835.advancedmd-direct.com

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": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356411763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 82819",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97282",
            "telephone_number": "503-233-5405",
            "fax_number": "503-233-2696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9670 SW BEAVERTON HILLSDALE HWY",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "97005",
            "telephone_number": "503-626-9494",
            "fax_number": "503-646-8401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JOSEPH",
        "middle_name": "HILLIARD",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164936",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAY",
            "last_name": "JOHNSON",
            "middle_name": "HILLIARD",
            "credential": "PHD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Beaverton, OR

Sources for this page

Verify at the official NPI Registry.