Jacquelyn Lee Johnson, C.N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

R108719-0 Issued in MN

Practice address

811 2ND St SE
Suite a
Little Falls, MN 56345-3559

Phone

(320) 631-7000

Fax

(320) 632-0534

NPI assigned

Jul 12, 2006

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

Other identifiers 7

Other names 1

• Ms. Jacquelyn Lee Ruzich Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

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 and National Provider Directory roles.

• Unity Family Healthcare

  • Orthopaedic Surgery Physician
  • Little Falls, MN
  • NPI 1326234006
  Medicare reassignment NPD
• Unity Family Healthcare

  • Home Health Agency
  • Little Falls, MN
  • NPI 1952329047
  NPD
• Unity Family Healthcare

  • Family Medicine Physician
  • Pierz, MN
  • NPI 1952530669
  NPD

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424044800000",
    "number": "1891710984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 2ND ST SE",
            "address_2": "SUITE A",
            "city": "LITTLE FALLS",
            "state": "MN",
            "postal_code": "563453559",
            "telephone_number": "320-631-7000",
            "fax_number": "320-632-0534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 2ND ST SE",
            "address_2": "SUITE A",
            "city": "LITTLE FALLS",
            "state": "MN",
            "postal_code": "563453559",
            "telephone_number": "320-631-7000",
            "fax_number": "320-632-0534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACQUELYN",
        "middle_name": "LEE",
        "name_prefix": "Ms.",
        "credential": "C.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2015-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "R108719-0",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0107328",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MINNESOTA",
            "identifier": "140376C736",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP33899",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "A024",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "NA9231028468",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044997100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MINNESOTA",
            "identifier": "47G13JO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "RUZICH",
            "middle_name": "LEE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Independent Disability Services
• Kristin Jackson, D.P.M.
• Brittney Jelinski
• JMBB, LLC
• Derek Paul Johnson, DPT
• Janine Johnson, RN, CNP
• Lisa Ann Johnson
• Paul Ryan Johnson, D.O.
• Randi Johnson, DDS
• David Jorgensen, M.D.

• Nurse Practitioner in Little Falls, MN
• Providers in Little Falls, MN by specialty
• Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2015; 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.