Individual provider Active NPI

Mark Foster Johnson

  • Psychiatric/Mental Health Nurse Practitioner
  • Redding, CA
National Provider Identifier
1801639141
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95030343 Issued in CA
Practice address
1742 Oregon St
Redding, CA 96001-1717
Phone
(530) 646-7269
NPI assigned
Jun 14, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95030343 CA Primary

Addresses

Primary practice location

1742 Oregon St
Redding, CA 96001-1717

Mailing address

PSC 37 Box 2903
Apo, AE 09459-0030

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240919001394 CA Practitioner - Nurse Practitioner 9335680289 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Native American Mental Health Services CorporationGroup PAC ID 5395072490, 62 clinicians

Practice addresses (Care Compare)

1742 Oregon St
Redding, CA 96001-1717
Phone (530) 646-7269

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

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": "1718323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1801639141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "PSC 37 BOX 2903",
            "city": "APO",
            "state": "AE",
            "postal_code": "094590030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1742 OREGON ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960011717",
            "telephone_number": "530-646-7269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARK",
        "middle_name": "FOSTER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-14",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95030343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redding, CA

Sources for this page

Verify at the official NPI Registry.