Individual provider Active NPI

Cynthia Lynne Johnson, PSYD

  • Psychologist
  • St. Paul, MN
National Provider Identifier
1639168446
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP3230 Issued in MN
Practice address
333 Smith Ave N, Mail Route 60222
St. Paul, MN 55102
Phone
(651) 241-8565
Fax
(651) 241-7168
NPI assigned
Oct 14, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X LP3230 MN Primary

Addresses

Primary practice location

333 Smith Ave N, Mail Route 60222
St. Paul, MN 55102

Mailing address

333 Smith Ave N, Mail Route 60222
St. Paul, MN 55102
Phone (651) 241-8565

Other identifiers 1

IdentifierTypeStateIssuer
2147165MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cjohnson293110@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: 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
I20060913000052 MN Practitioner - Clinical Psychologist 0446254080 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LP3230MNMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Jun 22, 2015 Accepting new patients
Allina Health System CurrentSince Jun 22, 2015 Accepting new patients
Allina Health System CurrentSince Jan 7, 2023 Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

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

800 E 28th St
Fl 6
Minneapolis, MN 55407
Phone (612) 863-5327

9055 Springbrook Dr NW
Minneapolis, MN 55433
Phone (763) 780-9155

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

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

480 Osborne Rd NE
Ste 260
Minneapolis, MN 55432
Phone (763) 236-3800

333 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-8256

280 Smith Ave N
Ste 450
Saint Paul, MN 55102
Phone (651) 241-5959

280 Smith Ave N
Ste 700
Saint Paul, MN 55102
Phone (651) 241-3535

333 Smith Ave N
#60222
Saint Paul, MN 55102
Phone (651) 241-8565

Interoperability endpoints

  • Direct secure messaging: cjohnson293110@excellian.direct.allina.com

Organizations & group practices 6

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": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1639168446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 SMITH AVE N, MAIL ROUTE 60222",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "55102",
            "telephone_number": "651-241-8565",
            "fax_number": "651-241-7168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 SMITH AVE N, MAIL ROUTE 60222",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "55102",
            "telephone_number": "651-241-8565",
            "fax_number": "651-241-7168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CYNTHIA",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-14",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2147165",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cjohnson293110@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "333 Smith Ave N, Mail Route 60222",
            "city": "St. Paul",
            "state": "MN",
            "country_code": "US",
            "postal_code": "55102",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in St. Paul, MN

Sources for this page

Verify at the official NPI Registry.