Individual provider Active NPI

Jeffrey Fordham Johns, M.D.

  • Psychiatry Physician
  • Berkeley, CA
National Provider Identifier
1922096932
Registry record updated Nov 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A93824 Issued in CA
Practice address
2640 Martin Luther King Jr Way
Berkeley, CA 94704-3238
Phone
(510) 981-5290
Fax
(510) 981-5265
NPI assigned
Oct 12, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A93824 CA Primary
Psychiatry Physician 2084P0800X 45624-020 WI

Addresses

Primary practice location

2640 Martin Luther King Jr Way
Berkeley, CA 94704-3238

Mailing address

2640 Martin Luther King Jr Way
Berkeley, CA 94704-3238
Phone (510) 981-5290

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081117000750 CA Practitioner - Psychiatry 5799845046 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
45624-020WIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alameda Health System CurrentSince Jan 31, 2017 Accepting new patients
City of Berkeley CurrentSince Aug 4, 2008 Accepting new patients
City of Berkeley CurrentSince Aug 4, 2008 Accepting new patients
Alameda Health System CurrentSince Jan 31, 2017 Accepting new patients
City of Berkeley Current Accepting new patients
Alameda Health System Current Accepting new patients
City of Berkeley PastSince Oct 10, 2021 Accepting new patients

Locations

2180 Milvia St
Fl 2
Berkeley, CA 94704
Phone (510) 981-5116

3282 Adeline St
Berkeley, CA 94703
Phone (510) 981-5280

2640 Mlk Way
Berkeley, CA 94704
Phone (510) 981-5290

1411 E 31st St
Oakland, CA 94602
Phone (510) 437-4323

Organizations & group practices 7

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": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351728000000",
    "number": "1922096932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2640 MARTIN LUTHER KING JR WAY",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947043238",
            "telephone_number": "510-981-5290",
            "fax_number": "510-981-5265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2640 MARTIN LUTHER KING JR WAY",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947043238",
            "telephone_number": "510-981-5290",
            "fax_number": "510-981-5265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNS",
        "first_name": "JEFFREY",
        "middle_name": "FORDHAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2012-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A93824",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "45624-020",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.