Jerrod K. Johnson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY8744 Issued in FL

Practice address

1881 N University Dr Ste 104
Coral Springs, FL 33071-6093

Phone

(954) 340-0888

Fax

(954) 346-0909

NPI assigned

Nov 19, 2012

Sex

Male

Sole proprietor

No

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 FL

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

Specialty

Clinical Psychologist

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• A Mindful Space Psychotherapy, LLC

  • Clinical Psychologist
  • Oakland Park, FL
  • NPI 1851115158
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1353283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1780928556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1881 N UNIVERSITY DR STE 104",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330716093",
            "telephone_number": "954-340-0888",
            "fax_number": "954-954-3460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1881 N UNIVERSITY DR STE 104",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330716093",
            "telephone_number": "954-340-0888",
            "fax_number": "954-346-0909"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4851 W Hillsboro Blvd",
            "address_2": "Suite A1",
            "address_purpose": "LOCATION",
            "city": "Coconut Creek",
            "state": "FL",
            "postal_code": "330734355",
            "country_code": "US",
            "telephone_number": "954-428-6020",
            "fax_number": "954-428-6022",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4851 W Hillsboro Blvd",
            "address_2": "Suite A1",
            "address_purpose": "LOCATION",
            "city": "Coconut Creek",
            "state": "FL",
            "postal_code": "330734355",
            "country_code": "US",
            "telephone_number": "954-428-6020",
            "fax_number": "954-428-6022",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JERROD",
        "middle_name": "K.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-19",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003599",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY8744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Serinah John
• Trina Johnson Pettiford
• Ashanti Johnson
• Dana Carol Johnson, MS CCC-SLP
• Elaine Lenore Johnson, LMT
• Justine Yvette Johnson
• Nathalie Johnson, PT
• Richard Edward Johnson, RPH
• Sylvia Patricia Johnson
• Taye-Lorne Johnson

• Clinical Psychologist in Coral Springs, FL
• Providers in Coral Springs, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.