Active NPI
Samuel Gary Johnson I, MA, LPC
- Professional Counselor
- Oil City, PA
National Provider Identifier
1710999735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PC003785
- Practice address
- 19 Central Ave
3Rd Floor
Oil City, PA 16301-2733 - Phone
- (814) 678-6900
- Fax
- (814) 678-6902
- NPI assigned
- Aug 12, 2006
- Last updated
- Feb 24, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC003785 | PA | Primary |
Addresses
Primary practice location
19 Central Ave
3Rd Floor
Oil City, PA 16301-2733
Mailing address
19 Central Ave
3Rd Floor
Oil City, PA 16301-2733
Phone (814) 678-6900
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 372735 | Other | PA | MHN |
| 1748907 | Other | PA | BLUE SHIELD |
| 565603 | Other | PA | VALUE OPTIONS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC003785 | PA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rural Mental Health Associates Inc | Professional | Past | Accepting new patients |
Organizations & group practices 1
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": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235433600000",
"number": "1710999735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 CENTRAL AVE",
"address_2": "3RD FLOOR",
"city": "OIL CITY",
"state": "PA",
"postal_code": "163012733",
"telephone_number": "814-678-6900",
"fax_number": "814-678-6902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 CENTRAL AVE",
"address_2": "3RD FLOOR",
"city": "OIL CITY",
"state": "PA",
"postal_code": "163012733",
"telephone_number": "814-678-6900",
"fax_number": "814-678-6902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "SAMUEL",
"middle_name": "GARY",
"name_suffix": "I",
"credential": "MA, LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-12",
"last_updated": "2009-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC003785",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN",
"identifier": "372735",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "1748907",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "565603",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oil City, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.