Individual provider Active NPI

Mark R Johnston, DPM

  • Podiatrist
  • Willmar, MN
National Provider Identifier
1912973058
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
546 Issued in MN
Practice address
101 Willmar Ave SW
Willmar, MN 56201
Phone
(320) 231-5000
Fax
(320) 231-5067
NPI assigned
Feb 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 546 MN Primary

Addresses

Primary practice location

101 Willmar Ave SW
Willmar, MN 56201

Mailing address

101 Willmar Ave SW
Willmar, MN 56201
Phone (320) 231-5000

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091230000566 MN Practitioner - Podiatry 8527109354 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare Clinic Southwest LLCGroup PAC ID 8426457946, 172 clinicians

Practice addresses (Care Compare)

101 Willmar Ave SW
Willmar, MN 56201-3556
Phone (320) 231-5000

600 Peterson Pkwy
New London, MN 56273-7823
Phone (320) 354-2222

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue35
Removal of skin lesions1-10
Removal of nail tissue469
Removal or shaving of skin growth59

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
CCM Health CurrentSince Feb 1, 2019 Accepting new patients
CCM Health CurrentSince Feb 1, 2019 Accepting new patients
Centracare Clinic Southwest LLC CurrentSince Oct 1, 2021 Accepting new patients
Centracare Clinic Southwest LLC CurrentSince Oct 1, 2021 Accepting new patients

Locations

824 N 11th St
Montevideo, MN 56265
Phone (320) 269-8877

600 Peterson Pkwy
New London, MN 56273
Phone (320) 354-2222

1100 E Broadway St
Redwood Falls, MN 56283
Phone (507) 637-2985

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

101 Willmar Ave SW
Willmar, MN 56201
Phone (320) 231-5079

Interoperability endpoints

  • Direct secure messaging: mjohnston29763@direct.centracare.com

Organizations & group practices 4

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 2

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": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1912973058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 WILLMAR AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "56201",
            "telephone_number": "320-231-5000",
            "fax_number": "320-231-5067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 WILLMAR AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "56201",
            "telephone_number": "320-231-5000",
            "fax_number": "320-231-5067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "MARK",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MN",
            "license": "546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willmar, MN

Sources for this page

Verify at the official NPI Registry.