Individual provider Active NPI

Amanda Johnson, PHD

  • Psychologist
  • Newton, IA
National Provider Identifier
1831409770
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
001202 Issued in IA
Practice address
1123 1St Ave E Ste 200
Newton, IA 50208-3981
Phone
(641) 792-4012
Fax
(641) 791-0697
NPI assigned
Oct 13, 2010
Last updated
Jan 4, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 001202 IA Primary

Addresses

Primary practice location

1123 1St Ave E Ste 200
Newton, IA 50208-3981

Mailing address

1123 1St Ave E Ste 200
Newton, IA 50208-3981
Phone (641) 792-4012

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20110812000171 IA Practitioner - Clinical Psychologist 6800065608 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Capstone Behavioral Healthcare IncGroup PAC ID 0648169573, 13 clinicians

Practice addresses (Care Compare)

200 4TH Ave W
Grinnell, IA 50112-1833
Phone (641) 528-6065

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
001202IAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Poweshiek County Mental Health Center Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1286928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1831409770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1123 1ST AVE E STE 200",
            "city": "NEWTON",
            "state": "IA",
            "postal_code": "502083981",
            "telephone_number": "641-792-4012",
            "fax_number": "641-791-0697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1123 1ST AVE E STE 200",
            "city": "NEWTON",
            "state": "IA",
            "postal_code": "502083981",
            "telephone_number": "641-792-4012",
            "fax_number": "641-791-0697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "AMANDA",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-13",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IA",
            "license": "001202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newton, IA

Sources for this page

Verify at the official NPI Registry.