Active NPI
Kristine L Johnson, OD
- Optometrist
- Burnsville, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- LD2587000
- Practice address
- 14000 Nicollet Ave
Burnsville, MN 55337-5790 - Phone
- (952) 428-0200
- NPI assigned
- Aug 16, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | LD2587000 | MN | Primary |
Addresses
Primary practice location
14000 Nicollet Ave
Burnsville, MN 55337-5790
Mailing address
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 041327500 | Medicaid | MN |
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: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3305 Central Park Village Dr
Suite 130
Eagan, MN 55121-7707
Phone (651) 406-8868
Merit-based Incentive Payment System (MIPS)
- Final score
- 88.63 of 100
- Quality
- 75.41
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 75.75
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD2587000 | MN | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairview Express Care | Current | Accepting new patients | |
| Fairview Express Care | Current | Accepting new patients | |
| Fairview Health Services | Current | Accepting new patients | |
| Fairview Clinics | Current | Accepting new patients | |
| Fairview Express Care | Current | Accepting new patients | |
| Fairview Health Services | Current | Accepting new patients | |
| Fairview Express Care | Current | Accepting new patients | |
| Fairview Clinics | Current | Accepting new patients |
Locations
1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860
3305 Central Park Village Dr
Ste 130
Eagan, MN 55121
Phone (651) 406-8701
10000 Zane Ave N
Minneapolis, MN 55443
Phone (763) 528-6999
2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800
6341 University Ave NE
Minneapolis, MN 55432
Phone (763) 427-9980
717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617
911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313
3305 Central Park Village Dr
#200
Saint Paul, MN 55121
Interoperability endpoints
- kjohnson397519@fairview.direct-ci.com
Organizations & group practices 9
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.
-
- Multi-Specialty Clinic/Center
- Minneapolis, MN
- NPI 1053952606
-
- Primary Care Clinic/Center
- Minneapolis, MN
- NPI 1346432218
-
- Emergency Medicine Physician
- Minneapolis, MN
- NPI 1811077175
-
- Primary Care Clinic/Center
- Saint Paul, MN
- NPI 1396552147
-
- Pain Clinic/Center
- Minneapolis, MN
- NPI 1457397150
-
- Pediatric Rehabilitation Medicine Physician
- Woodbury, MN
- NPI 1700235587
-
- General Practice Physician
- Edina, MN
- NPI 1831707207
-
- General Acute Care Hospital
- Minneapolis, MN
- NPI 1013994359
-
- Land Ambulance
- Saint Paul, MN
- NPI 1710212485
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321833600000",
"number": "1083606263",
"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": "612-262-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14000 NICOLLET AVE",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553375790",
"telephone_number": "952-428-0200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KRISTINE",
"middle_name": "L",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-16",
"last_updated": "2011-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "LD2587000",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "041327500",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Burnsville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2011; 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.