Staci R. Johnson, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A85895 Issued in CA

Practice address

4550 Eucalyptus Ave
Chino, CA 91710-9215

Phone

(310) 629-8989

NPI assigned

Aug 15, 2007

Last updated

Jul 31, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Staci R. Butler Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Howard University College of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

County of ImperialGroup PAC ID 9739166927, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• County of Imperial

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • El Centro, CA
  • NPI 1225258841
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1187136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343692800000",
    "number": "1790977502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 EUCALYPTUS AVE",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917109215",
            "telephone_number": "310-629-8989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 EUCALYPTUS AVE",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917109215",
            "telephone_number": "310-629-8989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "STACI",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-15",
        "last_updated": "2012-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A85895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACI",
            "last_name": "BUTLER",
            "middle_name": "R.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cagney Johnson
• Crystal Nicole Johnson, FNP-C
• Elizabeth Johnson X
• Jasmine Jaye Johnson
• Sarita Johnson
• Jonathan D Ou MD Inc
• Dervonshay Jones
• Joo Kim Dental Professional Corporation
• Victor Jordan, PH.D.
• Jose a Dheming MD Inc

• Psychiatry Physician in Chino, CA
• Providers in Chino, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2012; 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.