NPIMap

Individual provider Active NPI

Keary Lee Johnson, M.D.

  • Obstetrics & Gynecology Physician
  • New Ulm, MN
National Provider Identifier
1417335050
Registry record updated Feb 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
65868 Issued in MN
Practice address
1324 5TH St N
New Ulm, MN 56073
Phone
(507) 217-5000
NPI assigned
May 15, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 1, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X 57.026963 OH
Student in an Organized Health Care Education/Training Program 390200000X
Obstetrics & Gynecology Physician 207V00000X 65868 MN Primary

Addresses

Primary practice location

1324 5TH St N
New Ulm, MN 56073

Mailing address

P.O. Box 43
Route 10860
Minneapolis, MN 55440-0043
Phone (612) 262-1166

Other practice location 1

1324 5th St N
New Ulm, MN 56073
Phone (507) 217-5000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kjohnson436129@excellian.direct.allina.com Direct

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
I20190801002035 MN Practitioner - Obstetrics/Gynecology 9234448010 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Sanford School of Medicine of University of South Dakota, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

1324 5TH St N
New Ulm, MN 56073-1514
Phone (507) 217-1327

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
65868MNMDObstetrics & Gynecology Physician
57.026963OHMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health of Northern Minnesota Multi-Specialty Current Accepting new patients
Centracare Health System-NR LLC CurrentSince Oct 1, 2023 Accepting new patients
Centracare Health System-NR LLC Multi-Specialty CurrentSince Oct 1, 2023 Accepting new patients
Sanford Health of Northern Minnesota Multi-Specialty CurrentSince May 7, 2023 Accepting new patients
Sanford Health of Northern Minnesota Multi-Specialty CurrentSince May 7, 2023 Accepting new patients
Allina Health System CurrentSince Aug 1, 2019 Accepting new patients
Allina Health System Multi-Specialty Current Accepting new patients
Allina Health System CurrentSince Aug 1, 2019 Accepting new patients
Allina Health System Past Accepting new patients
Allina Health System Multi-Specialty Past Accepting new patients

Locations

1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020

1400 Highway 71
Intl Falls, MN 56649
Phone (218) 283-4481

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

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

1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303

1324 5th St N
New Ulm, MN 56073
Phone (507) 217-5000

625 N Jackson Ave
Springfield, MN 56087
Phone (507) 723-3523

Interoperability endpoints

  • Direct secure messaging: kjohnson436129@excellian.direct.allina.com

Organizations & group practices 10

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 4

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": "1431648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1417335050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 43",
            "address_2": "ROUTE 10860",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554400043",
            "telephone_number": "612-262-1166",
            "fax_number": "330-580-5513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1324 5TH ST N",
            "city": "NEW ULM",
            "state": "MN",
            "postal_code": "56073",
            "telephone_number": "507-217-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1324 5th St N",
            "address_purpose": "LOCATION",
            "city": "New Ulm",
            "state": "MN",
            "postal_code": "56073",
            "country_code": "US",
            "telephone_number": "507-217-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KEARY",
        "middle_name": "LEE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-15",
        "last_updated": "2023-02-01",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "57.026963",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "65868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kjohnson436129@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "1324 5th St N",
            "city": "New Ulm",
            "state": "MN",
            "country_code": "US",
            "postal_code": "56073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New Ulm, MN

Sources for this page

Verify at the official NPI Registry.