Individual provider Active NPI

Debora Bina Johnson, PSYD

  • Clinical Psychologist
  • Fort Worth, TX
National Provider Identifier
1851173918
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
40015 Issued in TX
Practice address
1550 W Rosedale St # 518
Fort Worth, TX 76104-7403
Phone
(181) 734-8835
NPI assigned
Oct 13, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 40015 TX Primary

Addresses

Primary practice location

1550 W Rosedale St # 518
Fort Worth, TX 76104-7403

Mailing address

8101 Sendero TRL Apt 3726
Fort Worth, TX 76177-6234
Phone (909) 446-6967

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20231030001051 TX Practitioner - Clinical Psychologist 6608222591 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deer Oaks Geriatric Services P CGroup PAC ID 9234034075, 45 clinicians

Practice addresses (Care Compare)

7272 Wurzbach Rd
San Antonio, TX 78240-4803
Phone (210) 615-3483

Merit-based Incentive Payment System (MIPS)

Final score
91.17 of 100Reported as group
Quality
83.48
Improvement activities
40
Cost
67.52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40015TXMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Deer Oaks Geriatric Services P C Clinical CurrentSince Oct 13, 2023 Accepting new patients
Deer Oaks Mental Health Associates PC Clinical Past Accepting new patients

Locations

1550 W Rosedale St
#518
Ft Worth, TX 76104
Phone (817) 348-8351

7272 Wurzbach Rd
Ste 706
San Antonio, TX 78240
Phone (210) 615-3401

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1697155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1851173918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8101 SENDERO TRL APT 3726",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761776234",
            "telephone_number": "909-446-6967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 W ROSEDALE ST # 518",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761047403",
            "telephone_number": "181-734-8835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DEBORA",
        "middle_name": "BINA",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-13",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "40015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.