NPIMap

Individual provider Active NPI

Ian Mark Johnson, PA-C

  • Physician Assistant
  • Edina, MN
National Provider Identifier
1922732452
Registry record updated Oct 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14703 Issued in MN
Practice address
7373 France Ave S Ste 408
Edina, MN 55435-4549
Phone
(651) 430-3800
Fax
(651) 430-3827
NPI assigned
Jul 11, 2022
Last updated
Oct 25, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 14703 MN Primary

Addresses

Primary practice location

7373 France Ave S Ste 408
Edina, MN 55435-4549

Mailing address

1950 Northwestern Ave S Ste 102
Stillwater, MN 55082-7615
Phone (651) 430-3800

Other practice location 1

5850 E Still Cir
Mesa, AZ 85206-3618
Phone (952) 300-0080

Other practice location 2

14545 Quentin Ave S
Savage, MN 55378-2782
Phone (952) 300-0080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231129001301 MN Practitioner - Physician Assistant 4880042001 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Memorial Health CareGroup PAC ID 0042123028, 502 clinicians

Practice addresses (Care Compare)

3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone (763) 581-5400

3366 Oakdale Ave N
Suite 200
Robbinsdale, MN 55422-2962
Phone (763) 520-5200

4181 108TH Ave NE
Blaine, MN 55449-7439
Phone (651) 430-3800

7270 Forestview LN N
Suite 100
Maple Grove, MN 55369-5555
Phone (651) 430-3800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Dec 24, 2023 Accepting new patients
North Memorial Health Care CurrentSince Dec 4, 2023 Accepting new patients
North Memorial Health Care CurrentSince Dec 4, 2023 Accepting new patients
Midwest Spine & Brain Institute, L.L.C. Physician Assistant CurrentSince Oct 29, 2023 Accepting new patients
Allina Health System CurrentSince Dec 24, 2023 Accepting new patients

Locations

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

7373 France Ave S
Ste 408
Minneapolis, MN 55435
Phone (952) 831-8228

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

3366 Oakdale Ave N
Ste 200
Robbinsdale, MN 55422
Phone (763) 287-5000

1950 Northwestern Ave S
Ste 102
Stillwater, MN 55082
Phone (651) 259-4515

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: ian.johnsonpac.p1@direct.midwestspinebrain.nextgenshare.com
  • Direct secure messaging: ijohnson647194@excellian.direct.allina.com

Organizations & group practices 7

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.

Hospital & facility affiliations 7

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": "1657497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1922732452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 NORTHWESTERN AVE S STE 102",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550827615",
            "telephone_number": "651-430-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7373 FRANCE AVE S STE 408",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354549",
            "telephone_number": "651-430-3800",
            "fax_number": "651-430-3827"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5850 E Still Cir",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852063618",
            "country_code": "US",
            "telephone_number": "952-300-0080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14545 Quentin Ave S",
            "address_purpose": "LOCATION",
            "city": "Savage",
            "state": "MN",
            "postal_code": "553782782",
            "country_code": "US",
            "telephone_number": "952-300-0080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "IAN",
        "middle_name": "MARK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-11",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.