Individual provider Active NPI

Robert Johnson

  • Specialist
  • Minneapolis, MN
National Provider Identifier
1740224732
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
22027 Issued in MN
Practice address
5 W Lake St
Minneapolis, MN 55408-3117
Phone
(612) 545-9000
NPI assigned
Jun 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 22027 MN Primary

Addresses

Primary practice location

5 W Lake St
Minneapolis, MN 55408-3117

Mailing address

7626 Carnelian LN
Eden Prairie, MN 55346-4345

Other identifiers 1

IdentifierTypeStateIssuer
589790400MedicaidMN

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050920000726 MN Practitioner - Sports MedicinePractitioner - Family Practice 4284668229 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
22027MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care CurrentSince Jan 1, 2019 Accepting new patients
Park Nicollet Clinic Current Accepting new patients
Tria Orthopaedic Center LLC CurrentSince Jan 1, 2011 Accepting new patients
Fairview Express Care Specialist CurrentSince Jan 1, 2019 Accepting new patients
Park Nicollet Methodist Hospital CurrentSince Jul 1, 2006 Accepting new patients
Park Nicollet Clinic CurrentSince Jul 1, 2006 Accepting new patients
Tria Orthopaedic Center LLC CurrentSince Jan 1, 2011 Accepting new patients
Fairview Express Care Current Accepting new patients
Hennepin Faculty Associates Past Accepting new patients

Locations

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

2525 University Ave SE
Minneapolis, MN 55414
Phone (612) 273-7827

8100 Northland Dr
Minneapolis, MN 55431
Phone (952) 831-1626

420 Delaware St SE
#126
Minneapolis, MN 55455
Phone (612) 626-2378

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

720 Washington Ave SE
Ste 300
Minneapolis, MN 55414
Phone (612) 884-0769

Organizations & group practices 9

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740224732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7626 CARNELIAN LN",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553464345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 W LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554083117",
            "telephone_number": "612-545-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ROBERT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MN",
            "license": "22027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "589790400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.