Active NPI
Keith Johnson, MD
- Family Medicine Physician
- Maple Grove, MN
National Provider Identifier
1013412956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 69882
- Practice address
- 9855 Hospital Dr Ste 102
Maple Grove, MN 55369-4648 - Phone
- (763) 581-5900
- Fax
- (763) 581-5901
- NPI assigned
- Mar 23, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 238295 | NC | |
| Family Medicine Physician | 207Q00000X | 69882 | MN | Primary |
Addresses
Primary practice location
9855 Hospital Dr Ste 102
Maple Grove, MN 55369-4648
Mailing address
2001 Vail Ave
Charlotte, NC 28207-1248
Phone (704) 304-7000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Arizona College of Medicine, 2018
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Hospital & facility affiliations
- North Memorial Health Hospital
- Abbott Northwestern Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Memorial Health Care | Current | Accepting new patients | |
| North Memorial Health Care | Current | Accepting new patients | |
| North Memorial Health Care | Current | Accepting new patients | |
| North Memorial Health Care | Past | Accepting new patients |
Locations
9855 Hospital Dr
Ste 104
Maple Grove, MN 55369
Phone (763) 581-5900
9855 Hospital Dr
Ste 102
Maple Grove, MN 55369
Phone (763) 581-5800
4209 Webber Pkwy
Minneapolis, MN 55412
Phone (763) 553-0544
3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048
Interoperability endpoints
- keith.johnson.1@17278.direct.athenahealth.com
- kjohnson168927@direct.northmemorial.com
Organizations & group practices 4
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.
-
- General Acute Care Hospital
- Robbinsdale, MN
- NPI 1851344907
-
- General Acute Care Hospital
- Robbinsdale, MN
- NPI 1568893220
-
- Clinic/Center
- Blaine, MN
- NPI 1841995552
-
- Primary Care Clinic/Center
- Minnetonka, MN
- NPI 1952732729
Hospital & facility affiliations 27
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Obesity Medicine (Family Medicine) Physician
- Minneapolis, MN
- NPI 1154684835
Hospital
-
- Physical Medicine & Rehabilitation Physician
- Minneapolis, MN
- NPI 1275577215
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627516800000",
"number": "1013412956",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2001 VAIL AVE",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282071248",
"telephone_number": "704-304-7000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9855 HOSPITAL DR STE 102",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553694648",
"telephone_number": "763-581-5900",
"fax_number": "763-581-5901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KEITH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-03-23",
"last_updated": "2021-07-29",
"certification_date": "2021-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NC",
"license": "238295",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "69882",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maple Grove, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.