Thor Johansen, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

71007301 Issued in IL

Practice address

4801 W Peterson Ave Ste 303
Chicago, IL 60646-5726

Phone

(773) 282-2322

NPI assigned

Jul 5, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Mountain Valley Regional Rehabilitation Hospital Inc

  dba MVRRH Physician Group

  • Multi-Specialty Clinic/Center
  • Prescott Valley, AZ
  • NPI 1780179044
  Medicare reassignment NPD
• Vibra Physicians LLC

  • Hospitalist Physician
  • Johnstown, CO
  • NPI 1659705424
  NPD

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801094446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3329 N HOYNE AVE # 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606186243",
            "telephone_number": "773-428-2449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 W PETERSON AVE STE 303",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606465726",
            "telephone_number": "773-282-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSEN",
        "first_name": "THOR",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "71007301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Johannesen
• Elora Johannsen, OTR/L
• Jennifer C Johansen, N.P.
• Melinda P Johansen, RN
• Sarah Elaine Thompson Johansen
• Adelaide Noelle Johanson, PA-C
• Krister M Johansson, MD
• John a. Quinn, D.D.S. PC (Dearborn Dentistry)
• John a. Vottero, MD, SC
• John Baxter Watson MD SC

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.