Individual provider Active NPI

Jillian Johannes, PA-C

  • Physician Assistant
  • Apple Valley, MN
National Provider Identifier
1083023733
Registry record updated Oct 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11670 Issued in MN
Practice address
14655 Galaxie Ave
Apple Valley, MN 55124-8602
Phone
(651) 241-3779
NPI assigned
Aug 7, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 11670 MN
Physician Assistant 363A00000X 11670 MN Primary

Addresses

Primary practice location

14655 Galaxie Ave
Apple Valley, MN 55124-8602

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-9000

Other practice location 1

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 254-3456

Other practice location 2

927 Churchill St W
Stillwater, MN 55082-6605
Phone (651) 439-5330

Other practice location 3

407 E 3rd St
Duluth, MN 55805-1950
Phone (218) 786-4000

Other practice location 4

405 Stageline Rd
Hudson, WI 54016-7848
Phone (715) 531-6000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jjohannes630157@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140929002442 MN Practitioner - Physician Assistant 6406076298 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

14655 Galaxie Ave
Apple Valley, MN 55124-8602
Phone (651) 241-3779

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

Hospital & facility affiliations

  • Accentcare Fairview Home Health - West, LLC Home health agency, Saint Paul, MN, CCN 247078
  • Allina United Hospital Hospital, Saint Paul, MN, CCN 240038

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
11670MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
St Marys Medical Center CurrentSince Sep 22, 2014 Accepting new patients
St. Mary'S Medical Center CurrentSince Sep 22, 2014 Accepting new patients
Allina Health System CurrentSince Jun 6, 2023 Accepting new patients
Allina Health System CurrentSince Jun 6, 2023 Accepting new patients
Allina Health System Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

407 E 3rd St
Duluth, MN 55805
Phone (218) 786-4357

402 E 2nd St
Duluth, MN 55805
Phone (218) 786-3443

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

14655 Galaxie Ave
Saint Paul, MN 55124
Phone (952) 432-4141

Interoperability endpoints

  • Direct secure messaging: jjohannes630157@excellian.direct.allina.com

Organizations & group practices 6

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.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697155200000",
    "number": "1083023733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14655 GALAXIE AVE",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551248602",
            "telephone_number": "651-241-3779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 Jackson St",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551012502",
            "country_code": "US",
            "telephone_number": "651-254-3456",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "927 Churchill St W",
            "address_purpose": "LOCATION",
            "city": "Stillwater",
            "state": "MN",
            "postal_code": "550826605",
            "country_code": "US",
            "telephone_number": "651-439-5330",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "407 E 3rd St",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558051950",
            "country_code": "US",
            "telephone_number": "218-786-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "405 Stageline Rd",
            "address_purpose": "LOCATION",
            "city": "Hudson",
            "state": "WI",
            "postal_code": "540167848",
            "country_code": "US",
            "telephone_number": "715-531-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHANNES",
        "first_name": "JILLIAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-07",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "11670",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jjohannes630157@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "14655 Galaxie Ave",
            "city": "Apple Valley",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551248602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Apple Valley, MN

Sources for this page

Verify at the official NPI Registry.