DR. STACY KIM JOHNSTON (PHD) – Clinical Psychologist, NPI 1063569135
Clinical Psychologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,473 CLINICAL PSYCHOLOGIST in CA
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Provider Addresses for DR. STACY KIM JOHNSTON (PHD)
4730 PALM AVE STE 202
LA MESA, CA 919415244
Phone: (619) 778-7215
Fax: (619) 328-9332
Type: Mailing
4730, Palm Avenue, La Mesa, San Diego County, California, 91941, United States
202
LA MESA, CA 919415266
Phone: (619) 778-7215
Fax: (619) 328-9332
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-08-24
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040824000570 | I | Clinical Psychologist | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 90837 | Psychotherapy, 1 hour | 204 | 13 | $0 |
Insurance plans in this area (ZIP 91941)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| P S Y C H I A T R Y | CA | |
| P S Y C H I A T R Y | MD | |
| Clinical Psychologist | CA | |
| Clinical Social Worker | CA | |
| Marriage And Family Therapist | CA | |
| Clinical Social Worker | CA | |
| Clinical Psychologist | CA | |
| Clinical Psychologist | CA | |
| Clinical Psychologist | CA | |
| Clinical Psychologist | CA |
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