Darrel Howard Johnsrud, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D9764 Issued in MN

Practice address

13998 Maple Knoll Way
#100
Maple Grove, MN 55369-7004

Phone

(763) 420-5599

Fax

(763) 416-4771

NPI assigned

Nov 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Rice Lake Dental, P.a.

  • Dental Clinic/Center
  • Maple Grove, MN
  • NPI 1760107502
  NPD Authorized official

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420588800000",
    "number": "1639244650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13998 MAPLE KNOLL WAY",
            "address_2": "#100",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697004",
            "telephone_number": "763-420-5599",
            "fax_number": "763-416-4771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13998 MAPLE KNOLL WAY",
            "address_2": "#100",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697004",
            "telephone_number": "763-420-5599",
            "fax_number": "763-416-4771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSRUD",
        "first_name": "DARREL",
        "middle_name": "HOWARD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2015-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D9764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Roy Johnson, PA-C
• Nicole Alyse Johnson
• Rachel Elizabeth Johnson, APRN, DNP, AGNP-C
• Sara Elizabeth Johnson, MSW, LICSW
• Valerie Johnson, P.T.
• Larae M Jome, PH.D.
• Candice Renne Jones
• Christopher James Jones, MD
• Elise Nicole Jones, DPT
• Lauren Riley Jones

• General Practice Dentistry in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.