Victoria Lecorian Johnson, MD is a medicare enrolled "Psychiatry & Neurology - Child & Adolescent Psychiatry" physician in Grosse Pointe Park, Michigan. Her current practice location is
15100 Mack Ave, Grosse Pointe Park, Michigan. You can reach out to her office (for appointments etc.) via phone at
(313) 824-4400.
Victoria Lecorian Johnson is licensed to practice in Michigan (license number EMC0002347) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1083094791.
Physician's Profile
Full Name | Victoria Lecorian Johnson |
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Gender | Female |
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Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
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Location | 15100 Mack Ave, Grosse Pointe Park, Michigan |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1083094791
- Provider Enumeration Date: 06/08/2015
- Last Update Date: 05/16/2024
Medicare PECOS Information:
- PECOS PAC ID: 2163732884
- Enrollment ID: I20220218000830
Medical Identifiers
Medical identifiers for Victoria Lecorian Johnson such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1083094791 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
2084P0800X | Psychiatry & Neurology - Psychiatry | A184505 (California) | Secondary |
2084P0800X | Psychiatry & Neurology - Psychiatry | 303597 (New York) | Secondary |
2084P0800X | Psychiatry & Neurology - Psychiatry | EMC0002347 (Michigan) | Secondary |
2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | A184505 (California) | Secondary |
2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 303597 (New York) | Secondary |
2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | EMC0002347 (Michigan) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Victoria Lecorian Johnson allows following entities to bill medicare on her behalf.
Entity Name | Valera Medical Pc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1437782349 PECOS PAC ID: 0547690521 Enrollment ID: O20200414003279 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Victoria Lecorian Johnson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Victoria Lecorian Johnson, MD 725 Welch Rd, Palo Alto, CA 94304-1601 Ph: (650) 497-8000 | Victoria Lecorian Johnson, MD 15100 Mack Ave, Grosse Pointe Park, MI 48230-6202 Ph: (313) 824-4400 |
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