Tracy C Marshall-Johnson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

88001119A Issued in IN

Practice address

1027 W Rudisill Blvd Ste 207
Fort Wayne, IN 46807-2160

Phone

(260) 444-7200

NPI assigned

Nov 21, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Mental Health Counselor

Education

Other, 2018

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 and National Provider Directory roles.

• Foster Park Counseling LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fort Wayne, IN
  • NPI 1407503238
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1574294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646179200000",
    "number": "1811533128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 W RUDISILL BLVD STE 207",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468072160",
            "telephone_number": "260-444-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 W RUDISILL BLVD STE 207",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468072160",
            "telephone_number": "260-444-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL-JOHNSON",
        "first_name": "TRACY",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-21",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "88001119A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811533128",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anna Marrah
• Sharon J. Marrs, FNP
• Sadie Marsden
• Megan Nicole Marsh, PSYD, HSPP
• Alysia Marshall Seslar
• Allysha Latina Marshall
• Ashley M. Marshall, N.P.
• Don A Marshall Jr., MD
• Kathryn K Marshall, RN
• Ainsley Catherine Martignetti

• Mental Health Counselor in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Mental Health Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; 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.