Individual provider Active NPI

Nicole Theresa Johnson, CNM

  • Midwife
  • Sioux Falls, SD
National Provider Identifier
1477214351
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
MidwifeTaxonomy code 176B00000X
License
CM000094 Issued in SD
Practice address
1417 S Cliff Ave Ste 400a
Sioux Falls, SD 57105-1064
Phone
(605) 322-8946
NPI assigned
Jan 4, 2022
Last updated
Jan 4, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Midwife 176B00000X CM000094 SD Primary

Addresses

Primary practice location

1417 S Cliff Ave Ste 400a
Sioux Falls, SD 57105-1064

Mailing address

3112 S 5TH Ave
Sioux Falls, SD 57105-5904
Phone (605) 351-4207

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220317001067 SD Practitioner - Certified Nurse Midwife (CNM) 7113312703 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
CM000094SDMDMidwife

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Feb 20, 2022 Accepting new patients
Avera McKennan CurrentSince Feb 20, 2022 Accepting new patients
Avera McKennan Current Accepting new patients
Avera McKennan Past Accepting new patients
Avera McKennan Past Accepting new patients

Locations

1417 S Cliff Ave
Ste 400A
Sioux Falls, SD 57105
Phone (605) 322-8877

1417 S Cliff Ave
Ste 401
Sioux Falls, SD 57105
Phone (605) 322-8920

Organizations & group practices 5

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1477214351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3112 S 5TH AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571055904",
            "telephone_number": "605-351-4207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 S CLIFF AVE STE 400A",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051064",
            "telephone_number": "605-322-8946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "NICOLE",
        "middle_name": "THERESA",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-04",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "SD",
            "license": "CM000094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.