Individual provider Active NPI

Jeremiah David Johnson, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Eagan, MN
National Provider Identifier
1386031433
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
71712 Issued in MN
Practice address
2700 Vikings Cir
Eagan, MN 55121-1002
Phone
(952) 456-7600
NPI assigned
Apr 15, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 71712 MN
Student in an Organized Health Care Education/Training Program 390200000X
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 71712 MN Primary

Addresses

Primary practice location

2700 Vikings Cir
Eagan, MN 55121-1002

Mailing address

4200 Dahlberg Dr Ste 300
Golden Valley, MN 55422-4841
Phone (952) 512-5600

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220902002442 MN Practitioner - Sports MedicinePractitioner - Orthopedic Surgery 5496057002 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Orthopedic Surgery
Education
University of Minnesota Medical School, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infinite Health Collaborative, PAGroup PAC ID 1052225042, 815 clinicians

Practice addresses (Care Compare)

2700 Vikings Cir
Eagan, MN 55121-1002
Phone (952) 456-7600

Hospital & facility affiliations

  • M Health Fairview Ridges Hospital Hospital, Burnsville, MN, CCN 240207
  • M Health Fairview Southdale Hospital Hospital, Edina, MN, CCN 240078

Merit-based Incentive Payment System (MIPS)

Final score
91.79 of 100Reported as group
Quality
95.08
Improvement activities
40
Cost
81.67

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Knee replacement1-10
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71712MNMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA Orthopaedic Surgery CurrentSince Sep 1, 2022 Accepting new patients
Infinite Health Collaborative, PA Orthopaedic Surgery CurrentSince Sep 1, 2022 Accepting new patients
St. Croix Orthopaedics, PA Past Accepting new patients
Infinite Health Collaborative, PA Past Accepting new patients

Locations

1000 W 140th St
Unit 201
Burnsville, MN 55337
Phone (952) 808-3000

1000 W 140th St
#202
Burnsville, MN 55337
Phone (952) 892-2200

2700 Vikings Cir
Eagan, MN 55121
Phone (952) 456-7600

4200 Dahlberg Dr
Ste 300
Minneapolis, MN 55422
Phone (952) 512-5600

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

Organizations & group practices 4

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 5

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": "1429056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1386031433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 DAHLBERG DR STE 300",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224841",
            "telephone_number": "952-512-5600",
            "fax_number": "952-512-5651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 VIKINGS CIR",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551211002",
            "telephone_number": "952-456-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JEREMIAH",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-15",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MN",
            "license": "71712",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "MN",
            "license": "71712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

Verify at the official NPI Registry.