Individual provider Active NPI

Shannon Kay Johnson, LMSW

  • Clinical Social Worker
  • Idaho Falls, ID
National Provider Identifier
1760924799
Registry record updated Nov 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LMSW-36196 Issued in ID
Practice address
2267 Teton PLZ
Idaho Falls, ID 83404-6486
Phone
(208) 522-0140
Fax
(208) 522-0141
NPI assigned
Nov 8, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LMSW-36196 ID Primary

Addresses

Primary practice location

2267 Teton PLZ
Idaho Falls, ID 83404-6486

Mailing address

2267 Teton PLZ
Idaho Falls, ID 83404-6486
Phone (208) 522-0140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20190411003182 ID Practitioner - Clinical Social Worker 2668713058 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Human Dynamics and Diagnostics LLCGroup PAC ID 1153644547, 10 clinicians

Practice addresses (Care Compare)

2267 Teton PLZ
Idaho Falls, ID 83404-6486
Phone 20852201401250

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LMSW-36196IDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Human Dynamics and Diagnostics, LLC CurrentSince Mar 21, 2019 Accepting new patients

Locations

2267 Teton Plz
Idaho Falls, ID 83404
Phone (208) 522-0140

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": "1478563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478563200000",
    "number": "1760924799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2267 TETON PLZ",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046486",
            "telephone_number": "208-522-0140",
            "fax_number": "208-522-0141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2267 TETON PLZ",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046486",
            "telephone_number": "208-522-0140",
            "fax_number": "208-522-0141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHANNON",
        "middle_name": "KAY",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-08",
        "last_updated": "2016-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LMSW-36196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.