Active NPI
Fenimore Johnson, PHD
- Clinical Psychologist
- Kalamazoo, MI
National Provider Identifier
1720038359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301001560
- 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
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 |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0C96409 | Other | MI | BCBSM |
| 6130469 | Other | MI | PHP |
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
Enrollment records 1
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
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
| License | State | Type | Specialty |
|---|---|---|---|
| 6301001560 | MI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neuropsychology Associates PLC | Clinical | Current | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.