Active NPI
Rennae I Johnson, PH D
- Clinical Psychologist
- Great Falls, MT
National Provider Identifier
1841291705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 196
- Practice address
- 400 15TH Ave S Ste 205
Great Falls, MT 59405-4375 - Phone
- (406) 731-8888
- Fax
- (406) 731-8876
- NPI assigned
- Aug 2, 2005
- Last updated
- Sep 7, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 196 | MT | Primary |
Addresses
Primary practice location
400 15TH Ave S Ste 205
Great Falls, MT 59405-4375
Mailing address
400 15TH Ave S Ste 205
Great Falls, MT 59405-4375
Phone (406) 731-8888
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0493103 | Medicaid | MT |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rennae.johnson.p1@direct.benefisbmg.nextgenshare.com | Benefis Hospitals Inc |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 196 | MT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694044800000",
"number": "1841291705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 15TH AVE S STE 205",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594054375",
"telephone_number": "406-731-8888",
"fax_number": "406-731-8876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 15TH AVE S STE 205",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594054375",
"telephone_number": "406-731-8888",
"fax_number": "406-731-8876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "RENNAE",
"middle_name": "I",
"credential": "PH D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-08-02",
"last_updated": "2023-09-07",
"certification_date": "2021-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MT",
"license": "196",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0493103",
"state": "MT"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rennae.johnson.p1@direct.benefisbmg.nextgenshare.com",
"affiliation": "Y",
"affiliationName": "Benefis Hospitals Inc",
"address_1": "400 15th Ave S Ste 205",
"city": "Great Falls",
"state": "MT",
"country_code": "US",
"postal_code": "594054375",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Great Falls, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.