Individual provider Active NPI

Jeshana E. Avent-Johnson, PSYD

  • Clinical Psychologist
  • Chino, CA
National Provider Identifier
1548747108
Registry record updated Jul 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY30170 Issued in CA
Practice address
13193 Central Ave Ste 200
Chino, CA 91710-4179
Phone
(909) 902-9111
Fax
(909) 902-9199
NPI assigned
Jul 25, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY30170 CA Primary

Addresses

Primary practice location

13193 Central Ave Ste 200
Chino, CA 91710-4179

Mailing address

13193 Central Ave Ste 200
Chino, CA 91710-4179
Phone (909) 902-9111

Other practice location 1

14390 Park Ave
Victorville, CA 92392-2310
Phone (442) 327-9311

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20181121000675 CA Practitioner - Clinical Psychologist 1153675590 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Foothills Psychological Services IncGroup PAC ID 9436157534, 37 clinicians

Practice addresses (Care Compare)

954 W Foothill Blvd
Suite a
Upland, CA 91786-3782
Phone (909) 946-4222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY30170CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Foothills Psychological Services, Inc. CurrentSince Sep 1, 2018 Accepting new patients

Locations

13193 Central Ave
Ste 200
Chino, CA 91710
Phone (909) 902-9111

5050 San Bernardino St
Montclair, CA 91763
Phone (909) 281-5800

1550 N Park Ave
Pomona, CA 91768
Phone (909) 623-0791

9089 Base Line Rd
Ste 200
Rch Cucamonga, CA 91730
Phone (909) 480-3567

600 N Euclid Ave
Ste 204
Upland, CA 91786
Phone (909) 379-1513

954 W Foothill Blvd
Ste A
Upland, CA 91786
Phone (909) 946-4222

14390 Park Ave
Victorville, CA 92392
Phone (442) 327-9311

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

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": "1532476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532476800000",
    "number": "1548747108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13193 CENTRAL AVE STE 200",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917104179",
            "telephone_number": "909-902-9111",
            "fax_number": "909-902-9199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13193 CENTRAL AVE STE 200",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917104179",
            "telephone_number": "909-902-9111",
            "fax_number": "909-902-9199"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14390 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Victorville",
            "state": "CA",
            "postal_code": "923922310",
            "country_code": "US",
            "telephone_number": "442-327-9311",
            "fax_number": "442-327-9313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AVENT-JOHNSON",
        "first_name": "JESHANA",
        "middle_name": "E.",
        "name_prefix": "Mrs.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-25",
        "last_updated": "2018-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY30170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino, CA

Sources for this page

Verify at the official NPI Registry.