Tina Marie Johnson, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

48536 Issued in MN

Practice address

1875 Woodwinds Dr
Woodbury, MN 55125-2298

Phone

(651) 232-6700

NPI assigned

Jan 2, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2019 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Olive Grove Hospice LLC

  • Community Based Hospice Care Agency
  • Blaine, MN
  • NPI 1871024794
  NPD (past)

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213660800000",
    "number": "1316004393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 WOODWINDS DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252298",
            "telephone_number": "651-232-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 WOODWINDS DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252298",
            "telephone_number": "651-232-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2008-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "48536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Valerie Johnson, PA-C
• Reed A Johnson, MD
• Rose Johnson, LPCC
• Ryan Daniel Johnson, OD
• Theresa Marie Johnson
• Travis Allan Johnson, D.D.S.
• Tyree Deshawn Johnson
• Victoria L Johnson, LPCC
• Rose Joiner, LMFT
• Lori Jokinen, DC

• Internal Medicine Physician in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Internal Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.