Individual provider Active NPI

John Fedje-Johnston, MD

  • Family Medicine Physician
  • Stillwater, MN
National Provider Identifier
1265419238
Registry record updated Mar 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
37118 Issued in MN
Practice address
1500 Curve Crest Blvd W
Stillwater, MN 55082-6040
Phone
(651) 439-1234
Fax
(651) 275-3325
NPI assigned
Dec 29, 2005
Last updated
Mar 17, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 37118 MN Primary

Addresses

Primary practice location

1500 Curve Crest Blvd W
Stillwater, MN 55082-6040

Mailing address

8170 33Rd Ave S
Mail Stop 21110Q
Minneapolis, MN 55440-1309

Other identifiers 1

IdentifierTypeStateIssuer
634287600MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. Current Accepting new patients

Locations

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8170 33rd Ave S
Minneapolis, MN 55425
Phone (952) 883-5463

8170 33rd Ave S
Stop 21110Q
Minneapolis, MN 55425

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

1500 Curve Crest Blvd W
Stillwater, MN 55082

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1265419238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "MAIL STOP 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554401309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 CURVE CREST BLVD W",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826040",
            "telephone_number": "651-439-1234",
            "fax_number": "651-275-3325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDJE-JOHNSTON",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "37118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "634287600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stillwater, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.