NPIMap

Individual provider Active NPI

Jamie Ann Johannes, DO

  • Family Medicine Physician
  • Lake Crystal, MN
National Provider Identifier
1407021637
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
51951 Issued in MN
Practice address
200 E Prince St
Lake Crystal, MN 56055-2043
Phone
(952) 200-5784
NPI assigned
Apr 29, 2008
Last updated
Sep 17, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 51951 MN Primary

Addresses

Primary practice location

200 E Prince St
Lake Crystal, MN 56055-2043

Mailing address

200 E Prince St
Lake Crystal, MN 56055-2043
Phone (507) 726-6966

Other names 1

  • Dr. Jamie Ann Gergen Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jjohannes90290@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100119000801 MN Practitioner - Family Practice 2365584026 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

101 Martin Luther King Dr
Jr
Mankato, MN 56001-6460
Phone (507) 385-6500

1025 Marsh St
Mankato, MN 56001-4752
Phone (507) 625-4031

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Jul 13, 2011 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Jul 13, 2011 Accepting new patients
Mayo Clinic Health System-St James Current Accepting new patients

Locations

1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

1101 Moulton and Parsons Dr
Saint James, MN 56081
Phone (507) 375-3261

Interoperability endpoints

  • Direct secure messaging: jjohannes90290@ehrdirect.mayoclinicmsg.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1407021637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E PRINCE ST",
            "city": "LAKE CRYSTAL",
            "state": "MN",
            "postal_code": "560552043",
            "telephone_number": "507-726-6966",
            "fax_number": "507-726-6939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E PRINCE ST",
            "city": "LAKE CRYSTAL",
            "state": "MN",
            "postal_code": "560552043",
            "telephone_number": "952-200-5784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANNES",
        "first_name": "JAMIE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-29",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "51951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jjohannes90290@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "200 E Prince St",
            "city": "Lake Crystal",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560552043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JAMIE",
            "last_name": "GERGEN",
            "middle_name": "ANN",
            "prefix": "DR.",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lake Crystal, MN

Sources for this page

Verify at the official NPI Registry.