Stasis Psychiatry, LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

STASIS PSYCHIATRY, LLC

Doing business as

Nathan Johnson, PMHNP

Practice address

4035 12TH St Cutoff SE Ste 120
Salem, OR 97302-1754

Phone

(971) 304-9306

Fax

(503) 926-6624

NPI assigned

Nov 15, 2018

Organization subpart

No

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

Authorized official

Name

Nathan Patrick Johnson, MSNNPI 1952754442

Title

Owner

Phone

(971) 304-9306

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Nathan Johnson, PMHNP Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nathan Patrick Johnson, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Salem, OR
  • NPI 1952754442

  Multi-Specialty

  Medicare reassignment NPD Authorized official
• Tarra Leani Baker, MSN

  • Psychiatric/Mental Health Nurse Practitioner
  • Salem, OR
  • NPI 1740736156
  NPD (past)

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

{
    "created_epoch": "1542240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618272000000",
    "number": "1427527886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12926",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973090926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4035 12TH ST CUTOFF SE STE 120",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973021754",
            "telephone_number": "971-304-9306",
            "fax_number": "503-926-6624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STASIS PSYCHIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-15",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "971-304-9306",
        "authorized_official_credential": "MSN"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1952754442",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500735377",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nathan Johnson, PMHNP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Psychiatric/Mental Health Nurse Practitioner in Salem, OR
• Providers in Salem, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.