Active NPI
Tegan Nicole John, D.O.
- Hospitalist Physician
- Brainerd, MN
National Provider Identifier
1669905337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospitalist Physician
- License
- 66083
- Practice address
- 523 N 3Rd St
Brainerd, MN 56401-3054 - Phone
- (218) 829-2861
- Fax
- (218) 828-3103
- NPI assigned
- Apr 9, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Hospitalist Physician | 208M00000X | 66083 | MN | Primary |
Addresses
Primary practice location
523 N 3Rd St
Brainerd, MN 56401-3054
Mailing address
1702 University Dr S
Fargo, ND 58103-4940
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: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Hospitalist
- Education
- Kansas City College of Medicine and Surgery, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
523 N 3Rd St
Brainerd, MN 56401-3054
Phone (218) 829-2861
Hospital & facility affiliations
- Essentia Health St Joseph'S Medical Center
- North Memorial Health Hospital
- Essentia Health St Mary'S Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66083 | MN | MD | Hospitalist Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Joseph'S Medical Center | Current | Accepting new patients | |
| St. Joseph'S Medical Center | Current | Accepting new patients | |
| St. Joseph'S Medical Center | Current | Accepting new patients |
Locations
523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394
Interoperability endpoints
- tjohn231207@direct.emplifyhealth.org
Organizations & group practices 3
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.
-
- General Acute Care Hospital
- Brainerd, MN
- NPI 1568415974
-
- Multi-Specialty Clinic/Center
- Staples, MN
- NPI 1538916101
-
- Primary Care Clinic/Center
- Pequot Lakes, MN
- NPI 1730134891
Hospital & facility affiliations 16
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Robbinsdale, MN
- NPI 1851344907
-
- General Acute Care Hospital
- Duluth, MN
- NPI 1457393035
-
- General Acute Care Hospital
- Brainerd, MN
- NPI 1568415974
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594684800000",
"number": "1669905337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1702 UNIVERSITY DR S",
"city": "FARGO",
"state": "ND",
"postal_code": "581034940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "523 N 3RD ST",
"city": "BRAINERD",
"state": "MN",
"postal_code": "564013054",
"telephone_number": "218-829-2861",
"fax_number": "218-828-3103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHN",
"first_name": "TEGAN",
"middle_name": "NICOLE",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-09",
"last_updated": "2020-07-14",
"certification_date": "2020-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "MN",
"license": "66083",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brainerd, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2020; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.