Jaclyn A Johnson, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

3952 Issued in MN

Practice address

1604 1St St S
Willmar, MN 56201-4243

Phone

(320) 231-6348

Fax

(320) 231-5067

NPI assigned

May 21, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

University of Minnesota Medical School, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Centracare Clinic Southwest LLCGroup PAC ID 8426457946, 172 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jschermer411054@direct.centracare.com

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.

• Centracare Clinic Southwest LLC

  • Multi-Specialty Clinic/Center
  • Willmar, MN
  • NPI 1174106264
  Medicare reassignment Care Compare group NPD
• Centracare Health - Benson LLC

  • Critical Access Hospital
  • Benson, MN
  • NPI 1326757154
  Medicare reassignment NPD
• Centracare Clinic Southwest LLC

  • Durable Medical Equipment & Medical Supplies
  • Willmar, MN
  • NPI 1912664889
  NPD
• Centracare Health - Benson LLC

  dba CentraCare - Benson

  • Rural Health Clinic/Center
  • Benson, MN
  • NPI 1023728516
  NPD
• Innovations for Aging, LLC

  • Case Management Agency
  • Minneapolis, MN
  • NPI 1437656840
  NPD
• Swift County Benson Hospital

  dba Swift County Benson Health Services

  • Family Medicine Physician
  • Benson, MN
  • NPI 1174077739
  NPD

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

{
    "created_epoch": "1526860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1811488430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1604 1ST ST S",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562014243",
            "telephone_number": "320-231-6348",
            "fax_number": "320-231-5067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 1ST ST S",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562014243",
            "telephone_number": "320-231-6348",
            "fax_number": "320-231-5067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACLYN",
        "middle_name": "A",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-21",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MN",
            "license": "3952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jschermer411054@direct.centracare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jschermer411054@direct.centracare.com",
            "address_1": "1604 1st St S",
            "city": "Willmar",
            "state": "MN",
            "country_code": "US",
            "postal_code": "562014243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alisa R Johnson, LPCC
• Amber Erin Johnson, WHNP
• Andrew Robert Johnson, LMFT
• Hannah Johnson
• Heather L Johnson, PHARMD
• Jeremy Johnson
• Karin Marie Johnson, MA
• Margaret A Johnson, MD
• Robert George Johnson, MD
• Seth Johnson, MSW, LICSW

• Registered Dietitian in Willmar, MN
• Providers in Willmar, MN by specialty
• Registered Dietitian in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.