Amanda Johnson, PHD
Individual provider Active NPI Psychologist · Newton, IA
NPI 1831409770 · NPPES record last updated Jan 4, 2022
Key facts
- NPI
- 1831409770
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 001202 (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
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Capstone Behavioral Healthcare Inc
Practice addresses (Care Compare)
200 4TH Ave W
Grinnell, IA 50112-1833
Phone (641) 528-6065
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110812000171 | IA | Practitioner - Clinical Psychologist | 6800065608 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001202 | IA | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Poweshiek County Mental Health Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 001202 | IA | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0069468 | Medicaid | IA |
Other providers in Newton, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.