Active NPI
Kristy Lynn Johnson, D.D.S.
- Periodontics
- Rochester, MN
National Provider Identifier
1679909212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- S110
- Practice address
- 2647 Superior Dr NW
Rochester, MN 55901-8525 - Phone
- (304) 841-3063
- NPI assigned
- Sep 14, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | S110 | MN | Primary |
Addresses
Primary practice location
2647 Superior Dr NW
Rochester, MN 55901-8525
Mailing address
2647 Superior Dr NW
Rochester, MN 55901-8525
Phone (304) 841-3063
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 13, 2017 through Mar 13, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S110 | MN | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628553600000",
"number": "1679909212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2647 SUPERIOR DR NW",
"city": "ROCHESTER",
"state": "MN",
"postal_code": "559018525",
"telephone_number": "304-841-3063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2647 SUPERIOR DR NW",
"city": "ROCHESTER",
"state": "MN",
"postal_code": "559018525",
"telephone_number": "304-841-3063"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KRISTY",
"middle_name": "LYNN",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-09-14",
"last_updated": "2021-08-10",
"certification_date": "2021-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MN",
"license": "S110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rochester, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.