Individual provider Active NPI

Fenimore Johnson, PHD

  • Clinical Psychologist
  • Kalamazoo, MI
National Provider Identifier
1720038359
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301001560 Issued in MI
Practice address
4328 W Michigan Ave
Kalamazoo, MI 49006-5823
Phone
(269) 375-2222
Fax
(269) 375-6078
NPI assigned
May 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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 6301001560 MI Primary

Addresses

Primary practice location

4328 W Michigan Ave
Kalamazoo, MI 49006-5823

Mailing address

4328 W Michigan Ave
Kalamazoo, MI 49006-5823
Phone (269) 375-2222

Other identifiers 2

IdentifierTypeStateIssuer
0C96409OtherMIBCBSM
6130469OtherMIPHP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20050125000346 MI Practitioner - Clinical Psychologist 1658321948 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neuropsychology Associates PLCGroup PAC ID 4385618297, 8 clinicians

Practice addresses (Care Compare)

4328 W Michigan Ave
Kalamazoo, MI 49006-5823
Phone (616) 375-2222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
6301001560MIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Neuropsychology Associates PLC Clinical CurrentSince Jun 1, 1998 Accepting new patients

Locations

5320 Holiday Ter
Ste 8
Kalamazoo, MI 49009
Phone (269) 375-6079

3325 Greenleaf Blvd
Kalamazoo, MI 49008

4328 W Michigan Ave
Kalamazoo, MI 49006
Phone (269) 375-2222

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1720038359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4328 W MICHIGAN AVE",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490065823",
            "telephone_number": "269-375-2222",
            "fax_number": "269-375-6078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4328 W MICHIGAN AVE",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490065823",
            "telephone_number": "269-375-2222",
            "fax_number": "269-375-6078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "FENIMORE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301001560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0C96409",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "6130469",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.