NPIMap

Individual provider Active NPI

Mark E Johnson, MD

  • Cardiovascular Disease Physician
  • Saint Cloud, MN
National Provider Identifier
1568454502
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
33783 Issued in MN
Practice address
1200 Sixth Ave N
Centracare Clinic
St Cloud, MN 56303-2735
Phone
(320) 252-5131
Fax
(320) 255-5714
NPI assigned
Aug 16, 2005
Last updated
Aug 26, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 33783 MN Primary

Addresses

Primary practice location

1200 Sixth Ave N
Centracare Clinic
St Cloud, MN 56303-2735

Mailing address

1200 Sixth Ave N
Centracare Clinic
St Cloud, MN 56303-2735
Phone (320) 252-5131

Other identifiers 10

IdentifierTypeStateIssuer
2529937OtherMEDICA HEALTH PLANS
600885OtherARAZ GROUP AMERICAS PPO
110904OtherU CARE
2114001OtherFIRST HEALTH PLAN
686002800MedicaidMN
686002800OtherMEDICAL ASSISTANCE
6D71JOOtherBLUE CROSS BLUE SHIELD
110104487OtherRR MEDICARE
986014OtherPREFERRED ONE
HP25456OtherHEALTH PARTNERS

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
I20091210000497 MN Practitioner - Cardiovascular Disease (Cardiology) 2466592191 Reassigns benefits to 9 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Sanford School of Medicine of University of South Dakota, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians
Astera HealthGroup PAC ID 2961395272, shared by 8 NPIs, 106 clinicians

Practice addresses (Care Compare)

111 17TH E Ave
Centracare Dialysis Alexandria
Alexandria, MN 56308-3703
Phone (800) 835-6652

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

1900 Centracare Cir
Saint Cloud, MN 56303-5000

4 Deerwood Ave NW
Wadena, MN 56482-1253
Phone (218) 631-1360

415 Jefferson St N
Wadena, MN 56482-1264
Phone (218) 631-7495

415 Jefferson St N
Wadena, MN 56482-1296

7418 Forthun Rd
Baxter, MN 56425-8702
Phone (218) 297-2048

815 2ND St SE
Little Falls, MN 56345-3505

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Health - Benson LLC CurrentSince May 1, 2024 Accepting new patients
Centracare Clinic Current Accepting new patients
Astera Health Current Accepting new patients
Swift County Benson Hospital Current Accepting new patients
Mille Lacs Health System CurrentSince Jan 1, 2024 Accepting new patients
Centracare Health System-NR LLC CurrentSince Sep 2, 2023 Accepting new patients
Centracare Clinic CurrentSince Jul 3, 1995 Accepting new patients
Mille Lacs Health System Current Accepting new patients
Centracare Health - Benson LLC CurrentSince May 1, 2024 Accepting new patients
Centracare Clinic CurrentSince Jul 3, 1995 Accepting new patients
Astera Health CurrentSince Jan 1, 2020 Accepting new patients
Mille Lacs Health System Current Accepting new patients
Centracare Health System-NR LLC Cardiovascular Disease Current Accepting new patients
Mille Lacs Health System Current Accepting new patients
Mille Lacs Health System CurrentSince Jan 1, 2024 Accepting new patients
Astera Health CurrentSince Jan 1, 2020 Accepting new patients
Centracare Clinic Past Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

1815 Wisconsin Ave
Benson, MN 56215
Phone (320) 843-3454

2024 S 6th St
Brainerd, MN 56401
Phone (218) 828-2880

523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394

27378 State Highway 18
Garrison, MN 56450
Phone (320) 692-5599

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

200 Elm St N
Onamia, MN 56359
Phone (320) 532-2750

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

4 Deerwood Ave NW
Wadena, MN 56482
Phone (218) 631-1100

415 Jefferson St N
Wadena, MN 56482
Phone (218) 631-3510

301 Becker Ave SW
Willmar, MN 56201
Phone (320) 231-4120

Interoperability endpoints

  • Direct secure messaging: mjohnson1356@direct.centracare.com

Organizations & group practices 18

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.

View all 18

Hospital & facility affiliations 11

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": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1568454502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 SIXTH AVE N",
            "address_2": "CENTRACARE CLINIC",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-252-5131",
            "fax_number": "320-240-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 SIXTH AVE N",
            "address_2": "CENTRACARE CLINIC",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-252-5131",
            "fax_number": "320-255-5714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARK",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MN",
            "license": "33783",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA HEALTH PLANS",
            "identifier": "2529937",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARAZ GROUP AMERICAS PPO",
            "identifier": "600885",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U CARE",
            "identifier": "110904",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH PLAN",
            "identifier": "2114001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "686002800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL ASSISTANCE",
            "identifier": "686002800",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "6D71JO",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110104487",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "986014",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP25456",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.