Active NPI
Melody B Johnson, PA-C
- Physician Assistant
- Eagan, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 13206
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 15
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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, WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
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
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2856 | AL | MD | Orthodontics and Dentofacial Orthopedic Dentist |
| PA.0009681 | CO | MD | Physician Assistant |
| PA9121569 | FL | MD | Physician Assistant |
| 137640 | IA | MD | Physician Assistant |
| 085012093 | IL | MD | Physician Assistant |
| 0010-16547 | NC | MD | Physician Assistant |
| 50.010217RX | OH | MD | Physician Assistant |
| 0110011741 | VA | MD | Physician Assistant |
| 13206 | MN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pine Medical Center | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| St. Mary's Hospital of Superior | Current | Accepting new patients | |
| Northern Pines Medical Center | Current | Accepting new patients | |
| Healtheast Medical Research Insititue | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| Fairview Health Services | Current | Accepting new patients | |
| Fairview Health Services | Current | Accepting new patients | |
| Essentia Health Moose Lake | Current | Accepting new patients | |
| SSM Health Care of Wisconsin, Inc. | Current | Accepting new patients | |
| The Duluth Clinic, LTD | Current | Accepting new patients | |
| SSM Health Care of Wisconsin, Inc. | Current | Accepting new patients | |
| The Duluth Clinic, LTD. | Current | Accepting new patients | |
| Northern Pines Medical Center | Current | Accepting new patients | |
| Moose Lake Community Hospital District | Current | Accepting new patients | |
| Healtheast Medical Research Institute | Current | 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.
-
dba Allina Health Buffalo Specialty Clinic
- Obstetrics & Gynecology Physician
- Buffalo, MN
- NPI 1295272342
-
dba HealthEast Vadnais Heights Clinic
- Clinic/Center
- Vadnais Heights, MN
- NPI 1639125503
-
dba Essentia Health Northern Pines
- Critical Access Hospital
- Aurora, MN
- NPI 1639278609
-
dba SSM Health St. Mary's Hospital-Madison
- General Acute Care Hospital
- Madison, WI
- NPI 1184621211
-
- Critical Access Hospital
- Moose Lake, MN
- NPI 1154959880
-
- Emergency Medicine Physician
- Minneapolis, MN
- NPI 1811077175
-
dba Essentia Health Sandstone
- Critical Access Hospital
- Sandstone, MN
- NPI 1326041633
-
dba Essentia Health Cloquet Clinic
- Multi-Specialty Clinic/Center
- Cloquet, MN
- NPI 1902563638
-
dba Essentia Health St. Mary's Hospital Superior
- Critical Access Hospital
- Superior, WI
- NPI 1083657886
-
dba United Hospital - Midwest Spine & Brain Institute
- Orthopaedic Surgery of the Spine Physician
- Saint Paul, MN
- NPI 1366221491
-
dba Allina Health TeleRheumatology
- Rheumatology Physician
- Coon Rapids, MN
- NPI 1952146516
-
dba Essentia Health Moose Lake Clinic
- Critical Access Hospital Clinic/Center
- Moose Lake, MN
- NPI 1275102048
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Allina Health Addiction and Psychotherapy-Mercy Hospital-Unity Campus
- Addiction (Substance Use Disorder) Psychologist
- Fridley, MN
- NPI 1083197214
Hospital
-
dba Allina Health Cancer Institute - Cambridge
- General Acute Care Hospital
- Cambridge, MN
- NPI 1215755400
-
dba Allina Health Inpatient Addiction Treatment -Mercy Hospital -Unity Campus
- Substance Use Disorder Rehabilitation Hospital Unit
- Fridley, MN
- NPI 1285692145
-
dba Allina Health Cancer Institute - Buffalo
- Radiation Oncology Clinic/Center
- Buffalo, MN
- NPI 1417548959
Hospital
-
dba Minnesota Perinatal Physicians - Mercy
- Maternal & Fetal Medicine Physician
- Coon Rapids, MN
- NPI 1447527767
Hospital
-
dba Allina Health Mental Health - Mercy Hospital, Unity Campus
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fridley, MN
- NPI 1598700528
Hospital
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.