Individual provider Active NPI

Dawn Marie Johnson, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Mishawaka, IN
National Provider Identifier
1467936070
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
71008402A Issued in IN
Practice address
215 W 4TH St
Mishawaka, IN 46544-1917
Phone
(574) 325-5961
NPI assigned
Sep 19, 2018
Last updated
Nov 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71008402A IN
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 71008402A IN Primary
Registered Nurse 163W00000X 28192361A IN

Addresses

Primary practice location

215 W 4TH St
Mishawaka, IN 46544-1917

Mailing address

215 W 4TH St
Mishawaka, IN 46544-1917
Phone (574) 325-5961

Other practice location 1

215 W 4th St Ste 101
Mishawaka, IN 46544-1917
Phone (574) 544-0608

Other practice location 2

215 W 4th St Ste 400
Mishawaka, IN 46544-1917
Phone (574) 544-0416

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181215000606 IN Practitioner - Nurse Practitioner 2163767344 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28192361AINMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana Center for Recovery Outpatient Services LLC Current Accepting new patients
Indiana Center for Recovery Outpatient Services LLC CurrentSince Jan 24, 2024 Accepting new patients
Indiana University Health Bloomington Inc Psychiatric/Mental Health CurrentSince Oct 8, 2018 Accepting new patients
Indiana University Health Bloomington Inc CurrentSince Oct 8, 2018 Accepting new patients
Indiana Center for Recovery South Bend, LLC Past Accepting new patients

Locations

7987 Solution Ctr
Chicago, IL 60677

601 W 2nd St
Bloomington, IN 47403
Phone (812) 353-5252

727 W 2nd St
Bloomington, IN 47403
Phone (812) 353-3450

714 N Senate Ave
Ste 130
Indianapolis, IN 46202
Phone (317) 963-5582

1578 E 85th Ave
Merrillville, IN 46410
Phone (219) 736-8955

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1537315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1467936070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 W 4TH ST",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465441917",
            "telephone_number": "574-325-5961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 W 4TH ST",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465441917",
            "telephone_number": "574-325-5961"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 W 4th St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465441917",
            "country_code": "US",
            "telephone_number": "574-544-0608",
            "fax_number": "574-544-0070",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "215 W 4th St Ste 400",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465441917",
            "country_code": "US",
            "telephone_number": "574-544-0416",
            "fax_number": "574-544-0066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DAWN",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-19",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71008402A",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71008402A",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28192361A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.