TIYA SHALYSE JOHNSON (M.D.) – Child & Adolescent Psychiatry Physician, NPI 1154696359
Child & Adolescent Psychiatry Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for TIYA SHALYSE JOHNSON (M.D.)
200 E Chestnut St
2nd Floor
Louisville, KY 402021831
Phone: (502) 588-0809
Type: Location
100 Executive Park # 103
Louisville, KY 40207
Phone: (502) 313-6877
Type: Location
11937 US HIGHWAY 271
TYLER, TX 757083154
Phone: (903) 877-7168
Fax: (903) 877-8355
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $113.
Total Amount is formed as General ($113) + Research ($0) + Ownership ($0) = $113.
Last reported payment date: 2024-08-27 • Largest payer in this snapshot: Ethicon US, LLC ($113).
Total Amount
$113
General + Research + Ownership
Payments
2
Total payment records
General Amount
$113
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-27
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Ethicon US, LLC | $113 |
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: 2020-08-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20180223002247 | I | Psychiatry | KY | TBD |
| I20200807001467 | I | Psychiatry | TX | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 40202)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| P S Y C H I A T R Y | MI | |
| Nurse Practitioner | OH | |
| - | OH | |
| - | IN | |
| - | KS | |
| Clinical Social Worker | FL | |
| P S Y C H I A T R Y | OH | |
| Mental Health Counselor | OH | |
| Mental Health Counselor | OH | |
| - | OH |
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