Devin J Johnson, MPT
Individual provider Active NPI Physical Therapist · Decorah, IA
NPI 1891737755 · NPPES record last updated Apr 3, 2018
Key facts
- NPI
- 1891737755
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 03097 (IA)
- Practice address
- 516 Montgomery St
Decorah, IA 52101-2720 - Phone
- (563) 382-4770
- Fax
- (563) 382-4785
- NPI assigned
- Jun 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- University of Iowa, RJ & L Carver College of Medicine, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gundersen Clinic LTD
Practice addresses (Care Compare)
516 Montgomery St
Decorah, IA 52101-2720
Phone (563) 382-4770
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101008000712 | IA | Practitioner - Physical Therapist in Private Practice | 5597837237 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03097 | IA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gundersen Lutheran Express Care, Inc | Current |
Accepting new patients | |
| Gundersen Clinic LTD | Current |
Accepting new patients | |
| Gundersen Clinic, LTD. | Past | Accepting new patients |
Locations
235 8th Ave W
Cresco, IA 52136
Phone (319) 547-2101
516 Montgomery St
Decorah, IA 52101
Phone (319) 382-4770
1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | 03097 | IA | |
| Sports Physical Therapist | 2251S0007X | 03097 | IA | |
| Orthopedic Physical Therapist | 2251X0800X | 03097 | IA | |
| Physical Therapist | 225100000X | 03097 | IA | Yes |
Addresses
Primary practice location
516 Montgomery St
Decorah, IA 52101-2720
Mailing address
1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36G94JO | Other | MN | BLUE CROSS BLUE SHEILD |
| 36G94JO | Other | MN | BLUE PLUS |
| 34706 | Other | IA | BLUE CROSS BLUE SHEILD |
| 421470451 | Other | IA | MAYO |
Other providers in Decorah, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.