Active NPI
Paul R Johnson, MD
- Anesthesiology Physician
- Maplewood, MN
National Provider Identifier
1871605451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 26849
- Practice address
- 1575 Beam Ave
Maplewood, MN 55109-1126 - Phone
- (651) 735-0501
- Fax
- (651) 735-1870
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 26849 | MN | Primary |
Addresses
Primary practice location
1575 Beam Ave
Maplewood, MN 55109-1126
Mailing address
8681 Eagle Point Blvd
Lake Elmo, MN 55042-8628
Phone (651) 251-8021
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 171073700 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26849 | MN | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268179200000",
"number": "1871605451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8681 EAGLE POINT BLVD",
"city": "LAKE ELMO",
"state": "MN",
"postal_code": "550428628",
"telephone_number": "651-251-8021",
"fax_number": "651-251-8050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1575 BEAM AVE",
"city": "MAPLEWOOD",
"state": "MN",
"postal_code": "551091126",
"telephone_number": "651-735-0501",
"fax_number": "651-735-1870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "PAUL",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2010-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "MN",
"license": "26849",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "171073700",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maplewood, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.