Individual provider Active NPI

Marissa Ann Virnig Johnson

  • Family Nurse Practitioner
  • Saint Cloud, MN
National Provider Identifier
1376431874
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
13065 Issued in MN
Practice address
1900 Centracare Cir Ste 1575
Saint Cloud, MN 56303-5000
Phone
(320) 229-4944
Fax
(320) 229-5156
NPI assigned
Jun 25, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 13065 MN Primary

Addresses

Primary practice location

1900 Centracare Cir Ste 1575
Saint Cloud, MN 56303-5000

Mailing address

5315 16TH St N
Saint Cloud, MN 56303-4674
Phone (320) 232-8903

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: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250801000597 MN Practitioner - Nurse Practitioner 8729596713 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Cloud HospitalGroup PAC ID 4880594779, 215 clinicians

Practice addresses (Care Compare)

1406 6TH Ave N
Saint Cloud, MN 56303-1900
Phone (320) 251-2700

Hospital & facility affiliations

  • Centracare - St. Cloud Hospital Hospital, Saint Cloud, MN, CCN 240036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13065MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Cloud Hospital CurrentSince Jul 11, 2025 Accepting new patients
St. Cloud Hospital CurrentSince Jul 11, 2025 Accepting new patients
St. Cloud Hospital Past Accepting new patients

Locations

1900 Centracare Cir
Ste 1575
Saint Cloud, MN 56303
Phone (320) 229-4922

1900 Centracare Cir
#157
Saint Cloud, MN 56303

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

110 2nd St S
Ste 104
Waite Park, MN 56387
Phone (320) 259-9375

Interoperability endpoints

  • Direct secure messaging: mjohnson880964@direct.centracare.com

Organizations & group practices 3

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1750809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752710400000",
    "number": "1376431874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5315 16TH ST N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034674",
            "telephone_number": "320-232-8903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 CENTRACARE CIR STE 1575",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563035000",
            "telephone_number": "320-229-4944",
            "fax_number": "320-229-5156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARISSA",
        "middle_name": "ANN VIRNIG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-25",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "13065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.