Individual provider Active NPI

Cheyne M Johnson, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Worcester, MA
National Provider Identifier
1508621608
Registry record updated Jul 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
RN2333067 Issued in MA
Practice address
309 Belmont St
Worcester, MA 01604-1059
Phone
(508) 368-3384
NPI assigned
Feb 19, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 4, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN2333067 MA Primary

Addresses

Primary practice location

309 Belmont St
Worcester, MA 01604-1059

Mailing address

482 Southbridge St # 363
Auburn, MA 01501-2468
Phone (774) 243-2624

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20241022002459 MA Practitioner - Nurse Practitioner 4385176833 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Commonwealth of Massachusetts CurrentSince Jul 29, 2024 Accepting new patients
The Commonwealth of Massachusetts CurrentSince Jul 29, 2024 Accepting new patients
Pharos Behavioral Health, PLLC Psychiatric/Mental Health Current Accepting new patients

Locations

482 Southbridge St
#363
Auburn, MA 01501

Organizations & group practices 3

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": "1708300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783123200000",
    "number": "1508621608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "482 SOUTHBRIDGE ST # 363",
            "city": "AUBURN",
            "state": "MA",
            "postal_code": "015012468",
            "telephone_number": "774-243-2624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 BELMONT ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016041059",
            "telephone_number": "508-368-3384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CHEYNE",
        "middle_name": "M",
        "credential": "APRN, PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-19",
        "last_updated": "2026-07-04",
        "certification_date": "2026-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2333067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.