Individual provider Active NPI

Kaisa L Johnson, C.N.M.

  • Midwife
  • St Louis Park, MN
National Provider Identifier
1821072992
Registry record updated Nov 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
MidwifeTaxonomy code 176B00000X
License
R149903-4 Issued in MN
Practice address
6490 Excelsior Blvd
Ste E111
St Louis Park, MN 55426-4705
Phone
(952) 993-5029
NPI assigned
Dec 2, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Midwife 176B00000X R149903-4 MN Primary

Addresses

Primary practice location

6490 Excelsior Blvd
Ste E111
St Louis Park, MN 55426-4705

Mailing address

6465 Wayzata Blvd
Ste 315
St Louis Park, MN 55426-1728

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100910001059 MN Practitioner - Certified Nurse Midwife (CNM) 1951426154 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
Columbia University College of Physicians and Surgeons, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-3123

Hospital & facility affiliations

  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
R149903-4MNMDMidwife

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Dec 21, 2009 Accepting new patients
Park Nicollet Clinic Current Accepting new patients
Park Nicollet Clinic CurrentSince Dec 21, 2009 Accepting new patients

Locations

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

6490 Excelsior Blvd
Ste E111
St Louis Park, MN 55426
Phone (952) 993-3490

6500 Excelsior Blvd
Fl 5
St Louis Park, MN 55426
Phone (952) 993-0377

Interoperability endpoints

  • Direct secure messaging: kjohnson136434@direct.healthpartners.com

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416182400000",
    "number": "1821072992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6465 WAYZATA BLVD",
            "address_2": "STE 315",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6490 EXCELSIOR BLVD",
            "address_2": "STE E111",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264705",
            "telephone_number": "952-993-5029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KAISA",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "C.N.M.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-02",
        "last_updated": "2014-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "MN",
            "license": "R149903-4",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.