Individual provider Active NPI

Roger Lee Johnson, MSW, LICSW

  • Clinical Social Worker
  • Grand Forks, ND
National Provider Identifier
1306880885
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
78 Issued in ND
Practice address
151 S 4TH St
Suite 401
Grand Forks, ND 58201-4715
Phone
(701) 795-3000
Fax
(701) 795-3050
NPI assigned
Jun 15, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 78 ND Primary

Addresses

Primary practice location

151 S 4TH St
Suite 401
Grand Forks, ND 58201-4715

Mailing address

151 S 4TH St
Suite 401
Grand Forks, ND 58201-4715
Phone (701) 795-3000

Other identifiers 3

IdentifierTypeStateIssuer
50B57JOOtherMNBCBS MN PROVIDER NUMBER
054519MedicaidND
005333OtherNDBCBS ND PROVIDER NUMBER

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

State licenses

LicenseStateTypeSpecialty
78NDMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1306880885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 S 4TH ST",
            "address_2": "SUITE 401",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014715",
            "telephone_number": "701-795-3000",
            "fax_number": "701-795-3050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 S 4TH ST",
            "address_2": "SUITE 401",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014715",
            "telephone_number": "701-795-3000",
            "fax_number": "701-795-3050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ROGER",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "78",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MN PROVIDER NUMBER",
            "identifier": "50B57JO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054519",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ND PROVIDER NUMBER",
            "identifier": "005333",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.