NPIMap

Individual provider Active NPI

Johanna Marie Bieberly

  • Family Nurse Practitioner
  • Memphis, TN
National Provider Identifier
1508892241
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
7712 Issued in TN
Practice address
2861 Broad Ave
Christ Community Health Services Inc
Memphis, TN 38112-2903
Phone
(901) 260-8450
Fax
(901) 260-8590
NPI assigned
Jun 24, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 7712 TN Primary
Registered Nurse 163W00000X 118463 TN

Addresses

Primary practice location

2861 Broad Ave
Christ Community Health Services Inc
Memphis, TN 38112-2903

Mailing address

2595 Central Ave
Memphis, TN 38104-5905
Phone (901) 260-8551

Other identifiers 1

IdentifierTypeStateIssuer
1016497MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
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
I20160906002603 SD Practitioner - Nurse Practitioner 0648165720 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians
Rural Health Care IncGroup PAC ID 3476447541, 156 clinicians

Practice addresses (Care Compare)

101 S Front St
Chamberlain, SD 57325-1612
Phone (605) 234-6584

101 S Front St
Chamberlain, SD 57325-1619
Phone (605) 234-6584

609 Garfield Ave
Murdo, SD 57559-4100
Phone (605) 669-2121

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
7712TNMDMental Health Counselor
118463TNMDRegistered Nurse
CP001093SDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Nov 1, 2016 Accepting new patients
Avera McKennan CurrentSince Nov 1, 2016 Accepting new patients
Avera McKennan Current Accepting new patients
Rural Health Care, Inc. Current Accepting new patients
Rural Health Care, Inc CurrentSince Aug 1, 2016 Accepting new patients
Rural Health Care, Inc CurrentSince Aug 1, 2016 Accepting new patients
Avera McKennan Past Accepting new patients
Avera McKennan Past Accepting new patients

Locations

101 S Front St
Chamberlain, SD 57325
Phone (605) 234-6584

101 S Front St
Ste 1
Chamberlain, SD 57325
Phone (605) 234-6584

101 S Front St
Ste 2
Chamberlain, SD 57325

Interoperability endpoints

  • Direct secure messaging: johanna.bieberly@avera.sdhealthlink.net

Organizations & group practices 8

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 26

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1508892241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2595 CENTRAL AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381045905",
            "telephone_number": "901-260-8551",
            "fax_number": "901-260-8590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2861 BROAD AVE",
            "address_2": "CHRIST COMMUNITY HEALTH SERVICES INC",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381122903",
            "telephone_number": "901-260-8450",
            "fax_number": "901-260-8590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIEBERLY",
        "first_name": "JOHANNA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-24",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "7712",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "118463",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1016497",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.