Mark L Johnson, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY27266 Issued in CA

Practice address

4400 Capitola Rd Ste 200
Capitola, CA 95010-3571

Phone

(931) 426-9302

Fax

(408) 378-4510

NPI assigned

May 21, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• Integrated Pain Management Medical Group, Inc.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Walnut Creek, CA
  • NPI 1922198779
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469577600000",
    "number": "1386904688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15047 LOS GATOS BLVD STE 200",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950322054",
            "telephone_number": "408-364-6799",
            "fax_number": "408-378-4510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 CAPITOLA RD STE 200",
            "city": "CAPITOLA",
            "state": "CA",
            "postal_code": "950103571",
            "telephone_number": "931-426-9302",
            "fax_number": "408-378-4510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARK",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-21",
        "last_updated": "2016-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY27266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PSYCHOLOGY LICENSE",
            "identifier": "PSY27266",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jay Pennock, MD a Professional Corporation
• Eunjung Jeon
• Joe Jiravisitcul, PHARM. D.
• John P Owens MD Inc
• Collin J Johnson, PT
• Joya Jones, PTA
• Nicole Michelle Jordan
• Joseph P Fogel MD Inc
• JSS Consulting, Inc.
• Bette Kaiser, MFT

• Clinical Psychologist in Capitola, CA
• Providers in Capitola, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.