Robert R Johnson, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

20A4908 Issued in CA

Practice address

3150 Bristol St Ste 400
Costa Mesa, CA 92626-3054

Phone

(949) 266-3700

Fax

(949) 266-3750

NPI assigned

Jul 28, 2006

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 28, 2014 through Jan 28, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

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.

• Amen Clinics, Inc

  • Diagnostic Neuroimaging (Psychiatry & Neurology) Physician
  • Costa Mesa, CA
  • NPI 1568865301
  NPD (past)

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496707200000",
    "number": "1437163953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3150 BRISTOL ST STE 400",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926263054",
            "telephone_number": "949-266-3700",
            "fax_number": "949-266-3750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 BRISTOL ST STE 400",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926263054",
            "telephone_number": "949-266-3700",
            "fax_number": "949-266-3750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ROBERT",
        "middle_name": "R",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2017-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "20A4908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX56630",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jazmyn Brianna Johnson
• Jennifer Michelle Johnson, M.P.H., R.D.
• Jordan J Johnson
• Megan Christine Johnson, M.D.
• Priscilla Johnson, NBC-HWC
• Samantha Maree Johnson
• Zachary Keith Johnson, M.A.
• Joy E. Johnston, MFT
• Maria Jollie, BCBA
• Taylor Janea Jones-Jackson

• Psychiatry Physician in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2017; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.