DR. STACY KIM JOHNSTON PHD
NPI 1063569135
Psychologist - Clinical in La Mesa, CA
About Dr. Stacy Kim Johnston Phd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. STACY KIM JOHNSTON PHD (NPI 1063569135) is an individual clinical provider in La Mesa, California, licensed in California (PSY17457) and active in the NPI registry since January 2007. She is enrolled in Medicare PECOS and is a graduate of Other (1998).
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Stacy Kim Johnston Phd is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
3Medicare enrollment records show Stacy Johnston reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
San Diego, CA 92123
- Reassigned Medicare billing, California enrollment
- 32 clinicians in this Medicare group
San Diego, CA 92101
- Reassigned Medicare billing, California enrollment
Carlsbad, CA 92008
- Reassigned Medicare billing, California enrollment
- 3 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 91941 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Stacy Johnston's NPI number?
The NPI number for Stacy Johnston is 1063569135. It was assigned to this individual provider in the NPPES registry on January 4, 2007.
Where is Stacy Johnston located?
Stacy Johnston practices at 4730 Palm Ave 202, La Mesa, CA 91941. The listed phone number is (619) 778-7215.
What is Stacy Johnston's specialty?
The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.
Is Stacy Johnston enrolled in Medicare?
Yes. Stacy Johnston is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Stacy Johnston's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Stacy Johnston reassigns Medicare benefits to 3 organizations: Southern California Psychology Centers, Apc (San Diego, CA), Stacy Kim Johnston Psychology, Inc. (San Diego, CA) and Pacific Psychology Centers, Apc. (Carlsbad, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Stacy Johnston's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Stacy Johnston was last updated on August 19, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dr. Stacy Kim Johnston, PHD · NPI 1063569135
Clinical provider in La Mesa, California. Individual provider, active in the CMS NPPES registry since January 4, 2007.
## Identity
- **NPI:** 1063569135 (Entity type: Individual)
- **Enumerated:** January 4, 2007
- **Primary specialty:** Psychologist - Clinical · taxonomy 103TC0700X
- **State license:** PSY17457 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 4730 PALM AVE, 202, La Mesa, CA 91941-5266
- **Phone:** (619) 778-7215 · **Fax:** (619) 328-9332
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): Southern California Psychology Centers, Apc (NPI 1386066363, San Diego, CA); Stacy Kim Johnston Psychology, Inc. (NPI 1316554322, San Diego, CA); Pacific Psychology Centers, Apc. (NPI 1295124998, Carlsbad, CA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 1998
## Record status
- **NPPES last updated:** August 19, 2013
- **Other identifiers:** Medicare PIN CP17457A (CA)
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Source: [NPI Profile](https://npiprofile.com/npi/1063569135) · Data from the CMS NPPES public registry.