Teresa Evelyn Johnson, DDS, MS, MPH, FASGD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D10071 Issued in MN

Practice address

115 Drew Ave SE
Madelia, MN 56062-1841

Phone

(507) 642-8742

Fax

(507) 642-2926

NPI assigned

Dec 13, 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 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• University Dental Associates

  • Dentist
  • Lincoln, NE
  • NPI 1780772301
  NPD (past)

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329868800000",
    "number": "1962563874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 DREW AVE SE",
            "city": "MADELIA",
            "state": "MN",
            "postal_code": "560621841",
            "telephone_number": "507-642-8742",
            "fax_number": "507-642-2926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 DREW AVE SE",
            "city": "MADELIA",
            "state": "MN",
            "postal_code": "560621841",
            "telephone_number": "507-642-8742",
            "fax_number": "507-642-2926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TERESA",
        "middle_name": "EVELYN",
        "credential": "DDS, MS, MPH, FASGD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2012-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D10071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "503822700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lacey Groebner, CNP
• Robyn Helget, LPCC, LPC, NCC
• Jamie Lynn Hitchcock
• Kathleen Anne Hoffman, P.T.
• Cherry Jeske, R.PH.
• Scott Michael Kirchner, D.C.
• Nikolai Bernhard Krahn, PMHNP-BC
• Jaimee Ann Kudrle, CNP, APRN, PMHNP
• Mary Lehman, PHARMD
• Patrice A Luker, LMFT

• General Practice Dentistry in Madelia, MN
• Providers in Madelia, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; 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.