Active NPI
Russell Adam Johnson, M.D.
- Child & Adolescent Psychiatry Physician
- Greeley, CO
National Provider Identifier
1831112341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 32618
- Practice address
- 3211 W 20TH St Ste D
Greeley, CO 80634-6566 - Phone
- (970) 356-3100
- Fax
- (970) 356-4827
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 32618 | CO | Primary |
Addresses
Primary practice location
3211 W 20TH St Ste D
Greeley, CO 80634-6566
Mailing address
3211 W 20TH St Ste D
Greeley, CO 80634-6566
Phone (970) 356-3100
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01326180 | Medicaid | CO | |
| 065216 | Other | CO | VALUE OPTIONS |
| 643345 | Other | CO | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32618 | CO | MD | Child & Adolescent Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pathways Management, LLC | Past | Accepting new patients |
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Greeley, CO
- NPI 1225147119
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1831112341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3211 W 20TH ST STE D",
"city": "GREELEY",
"state": "CO",
"postal_code": "806346566",
"telephone_number": "970-356-3100",
"fax_number": "970-356-4827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3211 W 20TH ST STE D",
"city": "GREELEY",
"state": "CO",
"postal_code": "806346566",
"telephone_number": "970-356-3100",
"fax_number": "970-356-4827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "RUSSELL",
"middle_name": "ADAM",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "CO",
"license": "32618",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01326180",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "065216",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "643345",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greeley, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.