Individual provider Active NPI

Melody B Johnson, PA-C

  • Physician Assistant
  • Eagan, MN
National Provider Identifier
1386295954
Registry record updated Aug 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13206 Issued in MN
Practice address
PO Box 211699
Eagan, MN 55121-3699
Phone
(866) 849-0692
NPI assigned
Sep 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2026

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

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.010217RX OH
Physician Assistant 363A00000X 0110011741 VA
Physician Assistant 363A00000X C5-0012484 DE
Physician Assistant 363A00000X 14287809-1206 UT
Physician Assistant 363A00000X 085012093 IL
Physician Assistant 363A00000X PA9121569 FL
Physician Assistant 363A00000X 2856 AL
Physician Assistant 363A00000X 14133 GA
Physician Assistant 363A00000X PA.0009681 CO
Physician Assistant 363A00000X 13206 MN Primary
Physician Assistant 363A00000X PA.70143677 WA
Physician Assistant 363A00000X 3473 NE
Physician Assistant 363A00000X 0010-16547 NC
Physician Assistant 363A00000X 10005425A IN
Physician Assistant 363A00000X 137640 IA

Addresses

Primary practice location

PO Box 211699
Eagan, MN 55121-3699

Mailing address

PO Box 211699
Eagan, MN 55121-3699
Phone (866) 849-0692

Other practice location 1

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 863-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20191105000985 MN Practitioner - Physician Assistant 2567794951 Reassigns benefits to 7 organizations
I20200423000685 WI Practitioner - Physician Assistant 2567794951 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

1575 Beam Ave
Maplewood, MN 55109-1126
Phone (651) 232-7000

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 863-4000

333 Smith Ave N
Saint Paul, MN 55102-2344
Phone (651) 241-8000

4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522
Phone (763) 236-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2856ALMDOrthodontics and Dentofacial Orthopedic Dentist
PA.0009681COMDPhysician Assistant
PA9121569FLMDPhysician Assistant
137640IAMDPhysician Assistant
085012093ILMDPhysician Assistant
0010-16547NCMDPhysician Assistant
50.010217RXOHMDPhysician Assistant
0110011741VAMDPhysician Assistant
13206MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Medical Center CurrentSince Jul 13, 2020 Accepting new patients
Allina Health System CurrentSince Mar 13, 2023 Accepting new patients
St. Mary's Hospital of Superior CurrentSince Mar 1, 2020 Accepting new patients
Northern Pines Medical Center CurrentSince Sep 5, 2022 Accepting new patients
Healtheast Medical Research Insititue CurrentSince Dec 23, 2023 Accepting new patients
Allina Health System CurrentSince Mar 13, 2023 Accepting new patients
Fairview Health Services CurrentSince Sep 1, 2025 Accepting new patients
Fairview Health Services CurrentSince Sep 1, 2025 Accepting new patients
Essentia Health Moose Lake CurrentSince Jun 16, 2022 Accepting new patients
SSM Health Care of Wisconsin, Inc. CurrentSince Mar 16, 2024 Accepting new patients
The Duluth Clinic, LTD CurrentSince Dec 23, 2019 Accepting new patients
SSM Health Care of Wisconsin, Inc. CurrentSince Mar 16, 2024 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Dec 23, 2019 Accepting new patients
Northern Pines Medical Center CurrentSince Sep 5, 2022 Accepting new patients
Moose Lake Community Hospital District Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Dec 23, 2023 Accepting new patients

Locations

7153 Solutions Ctr
Chicago, IL 60677

5211 Highway 110
Aurora, MN 55705
Phone (218) 229-1010

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

4572 County Road 61
Moose Lake, MN 55767
Phone (218) 485-4481

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

705 Lundorff Dr
Sandstone, MN 55072
Phone (320) 245-2211

603 9th St N
Virginia, MN 55792
Phone (218) 741-3013

700 S Park St
Madison, WI 53715
Phone (608) 260-2900

3500 Tower Ave
Superior, WI 54880
Phone (715) 392-8281

Organizations & group practices 23

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 23

Hospital & facility affiliations 8

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": "1569369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785801600000",
    "number": "1386295954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 211699",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551213699",
            "telephone_number": "866-849-0692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 211699",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551213699",
            "telephone_number": "866-849-0692"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2925 Chicago Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554071321",
            "country_code": "US",
            "telephone_number": "612-863-4000",
            "fax_number": "763-236-3026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MELODY",
        "middle_name": "B",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-25",
        "last_updated": "2026-08-04",
        "certification_date": "2026-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.010217RX",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110011741",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0012484",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "14287809-1206",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085012093",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9121569",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "2856",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "14133",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0009681",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13206",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA.70143677",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "3473",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-16547",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10005425A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "137640",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

Verify at the official NPI Registry.