Individual provider Active NPI

Miranda M Johnson

  • Marriage & Family Therapist
  • Northfield, MN
National Provider Identifier
1558958462
Registry record updated Dec 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Practice address
570 Professional Dr
Northfield, MN 55057-2756
Phone
(507) 301-3412
NPI assigned
Dec 26, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X Primary

Addresses

Primary practice location

570 Professional Dr
Northfield, MN 55057-2756

Mailing address

570 Professional Dr
Northfield, MN 55057-2756

Other practice location 1

570 Professional Dr
Northfield, MN 55057-2756
Phone (507) 301-3412 ext. 1042

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20240715000323 MN Practitioner - Marriage and Family Therapist 6406391457 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Secure Base Counseling Center LLCGroup PAC ID 8628409299, 22 clinicians

Practice addresses (Care Compare)

570 Professional Dr
Northfield, MN 55057-2756
Phone (507) 301-3412

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Secure Base Counseling Center LLC Marriage & Family Therapist CurrentSince Jun 1, 2024 Accepting new patients

Locations

213 1st St
Farmington, MN 55024
Phone (507) 301-3412

301 Main St E
New Prague, MN 56071
Phone (612) 758-4431

570 Professional Dr
Northfield, MN 55057
Phone (507) 301-3412

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1608940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608940800000",
    "number": "1558958462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 PROFESSIONAL DR",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550572756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 PROFESSIONAL DR",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550572756",
            "telephone_number": "507-301-3412"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "570 Professional Dr",
            "address_purpose": "LOCATION",
            "city": "Northfield",
            "state": "MN",
            "postal_code": "550572756",
            "country_code": "US",
            "telephone_number": "507-301-3412 x1042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MIRANDA",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-26",
        "last_updated": "2020-12-26",
        "certification_date": "2020-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northfield, MN

Sources for this page

Verify at the official NPI Registry.