Active NPI
John Edward Landers, PH.D.
- Clinical Psychologist
- Idaho Falls, ID
National Provider Identifier
1982924411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY-202268
- Practice address
- 2280 E 25TH St
Idaho Falls, ID 83404-7542 - Phone
- (208) 227-2100
- NPI assigned
- Jun 7, 2010
- Sex
- Male
- 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 | PSY-202268 | ID | Primary |
Addresses
Primary practice location
2280 E 25TH St
Idaho Falls, ID 83404-7542
Mailing address
2280 E 25TH St
Idaho Falls, ID 83404-7542
Phone (208) 227-2100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-202268 | ID | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychological Service Associates | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Psychologist
- Idaho Falls, ID
- NPI 1871672840
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275868800000",
"number": "1982924411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2280 E 25TH ST",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834047542",
"telephone_number": "208-227-2100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2280 E 25TH ST",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834047542",
"telephone_number": "208-227-2100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANDERS",
"first_name": "JOHN",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-07",
"last_updated": "2010-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "ID",
"license": "PSY-202268",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.