Colin James Johnson, D.O
Individual provider Active NPI Emergency Medicine Physician · Fargo, ND
NPI 1346780228 · NPPES record last updated Jun 17, 2020
Key facts
- NPI
- 1346780228
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 16436 (ND)
- Practice address
- 3000 32ND Ave S
Fargo, ND 58103-6132 - Phone
- (701) 364-8000
- Fax
- (701) 364-8078
- NPI assigned
- Feb 27, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- West Virginia School of Osteopathic Medicine, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Innovis Health LLC
Practice addresses (Care Compare)
3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000
Hospital & facility affiliations
- Essentia Health
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200622002299 | ND | Practitioner - Emergency Medicine | 5698044287 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 67084 | MN | MD | Emergency Medicine Physician |
| 16436 | ND | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovis Health, LLC | Current | Accepting new patients | |
| Innovis Health LLC | Current |
Accepting new patients | |
| Innovis Health LLC | Current |
Accepting new patients |
Locations
3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000
1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 16436 | ND | Yes |
| Emergency Medicine Physician | 207P00000X | 67084 | MN | |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
3000 32ND Ave S
Fargo, ND 58103-6132
Mailing address
1702 University Dr S
Fargo, ND 58103-4940
Other providers in Fargo, ND
- Chantel Johnson
- Charlene Johnson
- Charlsey Johnson
- Chase Johnson
- Chloe L Johnson
- Craig D Johnson
- Cybil Johnson
- Cynthia Johnson
- Daniel David Johnson
- Denise L Johnson
All providers in Fargo, ND · Emergency Medicine Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.