Ronn Mark Johnson, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY18784 Issued in CA

Practice address

603 Hemlock St Ste 2C-3
Brookings, OR 97415-9424

Phone

(541) 661-6479

Fax

(541) 412-7087

NPI assigned

May 25, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, OR2 enrollments

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 2

Specialty

Clinical Psychologist

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• Redwood Coaching and Consulting LLC

  • Psychologist
  • Brookings, OR
  • NPI 1811465172
  NPD (past)

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1699986000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4245",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "974150064",
            "telephone_number": "541-661-6479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 HEMLOCK ST STE 2C-3",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "974159424",
            "telephone_number": "541-661-6479",
            "fax_number": "541-412-7087"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1305 Northcrest Dr Ste 2",
            "address_purpose": "LOCATION",
            "city": "Crescent City",
            "state": "CA",
            "postal_code": "955312322",
            "country_code": "US",
            "telephone_number": "541-661-6479",
            "fax_number": "541-412-7087",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "RONN",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1567",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY18784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iph Security Systems, Inc
• Christi M Irwin
• James E Brown, LMFT, LPC
• John C and Marian Boye, PC
• Robert Tovey Johnson, DC
• Ryan Johnson, DMD
• Steven Folke Johnson, M.D.
• Charles E Jones Jr., D.D.S.
• Kayci Michele Jones
• Christopher Joos

• Clinical Psychologist in Brookings, OR
• Providers in Brookings, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.