Active NPI
Ross Adam Johnston, PSYD
- Clinical Psychologist
- Wilmington, NC
National Provider Identifier
1912518556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 103392
- Practice address
- 5015 Oleander Dr
Wilmington, NC 28403-7016 - Phone
- (910) 777-7858
- NPI assigned
- Aug 16, 2020
- Sex
- Male
- Sole proprietor
- No
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 | 103392 | NC | Primary |
Addresses
Primary practice location
5015 Oleander Dr
Wilmington, NC 28403-7016
Mailing address
814 N 3Rd St Apt 125
Wilmington, NC 28401-3577
Phone (302) 290-9872
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 22, 2021 through Mar 22, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5810 | NC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597536000000",
"number": "1912518556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "814 N 3RD ST APT 125",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284013577",
"telephone_number": "302-290-9872"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5015 OLEANDER DR",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284037016",
"telephone_number": "910-777-7858"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSTON",
"first_name": "ROSS",
"middle_name": "ADAM",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-16",
"last_updated": "2020-08-16",
"certification_date": "2020-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "103392",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.