Spencer Allan Johnson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

022174 Issued in MN

Practice address

4001 Stinson Blvd
Ste 404
Minneapolis, MN 55421-3488

Phone

(612) 706-9630

NPI assigned

Jul 7, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Medical Care Services, PA

  • Family Medicine Physician
  • New Brighton, MN
  • NPI 1083778708
  Medicare reassignment NPD Authorized official
• Health and Wellness Collaborative

  • Clinical Psychologist
  • New Brighton, MN
  • NPI 1548822943

  Family Medicine

  NPD

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881692549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 STINSON BLVD",
            "address_2": "STE 404",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554213488",
            "telephone_number": "612-706-9630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 STINSON BLVD",
            "address_2": "STE 404",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554213488",
            "telephone_number": "612-706-9630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SPENCER",
        "middle_name": "ALLAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "022174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Johnson, MSW, LICSW
• Sarah E Johnson, RD LD
• Sarah Suzanne Johnson, LICSW
• Shannon Lynn Johnson, RN
• Shelana M Johnson
• Steffanie A Johnson, LMFT
• Stephanie Ann Johnson, LPC
• Stephanie Diane Johnson, LGSW
• Susan Catherine Johnson
• Susan Marie Johnson, APRN, CNP

• Family Medicine Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.