Active NPI
Johnathan Michael Roy
- Professional Counselor
- Lincoln, NE
National Provider Identifier
1790120194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 5383
- Practice address
- 3201 Pioneers Blvd Ste 218
Lincoln, NE 68502-5963 - Phone
- (402) 413-7171
- NPI assigned
- Apr 30, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Professional Counselor | 101YP2500X | 5383 | NE | Primary |
Addresses
Primary practice location
3201 Pioneers Blvd Ste 218
Lincoln, NE 68502-5963
Mailing address
3201 Pioneers Blvd Ste 218
Lincoln, NE 68502-5963
Phone (402) 413-5525
Other practice location 1
1430 Olive St Ste 500
Saint Louis, MO 63103-2377
Phone (314) 206-3700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5383 | NE | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592870400000",
"number": "1790120194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3201 PIONEERS BLVD STE 218",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685025963",
"telephone_number": "402-413-5525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3201 PIONEERS BLVD STE 218",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685025963",
"telephone_number": "402-413-7171"
}
],
"practiceLocations": [
{
"address_1": "1430 Olive St Ste 500",
"address_purpose": "LOCATION",
"city": "Saint Louis",
"state": "MO",
"postal_code": "631032377",
"country_code": "US",
"telephone_number": "314-206-3700",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROY",
"first_name": "JOHNATHAN",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-04-30",
"last_updated": "2020-06-23",
"certification_date": "2020-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NE",
"license": "5383",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lincoln, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.