Mrs Kyrsten Ann Johnson, MD - Medicare Pediatrics in Maple Grove, MN

Mrs Kyrsten Ann Johnson, MD is a medicare enrolled "Pediatrics" physician in Maple Grove, Minnesota. Her current practice location is 12000 Elm Creek Blvd N, Suite 250, Maple Grove, Minnesota. You can reach out to her office (for appointments etc.) via phone at (952) 401-8300.

Mrs Kyrsten Ann Johnson is licensed to practice in Minnesota (license number 60466) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1487997037.

Contact Information

Mrs Kyrsten Ann Johnson, MD
12000 Elm Creek Blvd N, Suite 250,
Maple Grove, MN 55369-7073
(952) 401-8300
(952) 401-8242



Physician's Profile

Full NameMrs Kyrsten Ann Johnson
GenderFemale
SpecialityPediatrics
Location12000 Elm Creek Blvd N, Maple Grove, Minnesota
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1487997037
  • Provider Enumeration Date: 04/02/2013
  • Last Update Date: 09/19/2017
  Medicare PECOS Information:
  • PECOS PAC ID: 0749411387
  • Enrollment ID: I20161020000690

Medical Identifiers

Medical identifiers for Mrs Kyrsten Ann Johnson such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1487997037NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
208000000XPediatrics 60466 (Minnesota)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Kyrsten Ann Johnson allows following entities to bill medicare on her behalf.
Entity NameSouth Lake Clinic Pa
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1427027184
PECOS PAC ID: 3173500303
Enrollment ID: O20040706000564

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Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Kyrsten Ann Johnson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Mrs Kyrsten Ann Johnson, MD
17705 Hutchins Dr., # 250,
Minnetonka, MN 55345

Ph: (952) 401-8300
Mrs Kyrsten Ann Johnson, MD
12000 Elm Creek Blvd N, Suite 250,
Maple Grove, MN 55369-7073

Ph: (952) 401-8300

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Pediatrics Doctors in Maple Grove, MN

Laura Woodbeck Moustafa,
Pediatrics
Medicare: Medicare Enrolled
Practice Location: 12720 Bass Lake Rd, Maple Grove, MN 55369
Phone: 763-559-2861    
Dr. Susan K. Mahle, M.D.
Pediatrics
Medicare: Not Enrolled in Medicare
Practice Location: 12720 Bass Lake Rd, Maple Grove, MN 55369
Phone: 763-559-2861    Fax: 763-559-1338
Pamela Jean Niksich, M.D.
Pediatrics
Medicare: Medicare Enrolled
Practice Location: 12720 Bass Lake Rd, Maple Grove, MN 55369
Phone: 763-559-2861    Fax: 763-559-1338
Gretchen A Voge, MD
Pediatrics
Medicare: Medicare Enrolled
Practice Location: 9875 Hospital Dr, Maple Grove, MN 55369
Phone: 888-455-2229    
Aaron Wendell Swenson, M.D.
Pediatrics
Medicare: Medicare Enrolled
Practice Location: 9325 Upland Lane N, Suite 360, Maple Grove, MN 55369
Phone: 612-322-6903    
Jeanne D Mrozek, MD
Pediatrics
Medicare: Medicare Enrolled
Practice Location: 9325 Upland Lane N, Suite 360, Maple Grove, MN 55369
Phone: 612-813-6475    
Dr. Rebecca A Doege, MD
Pediatrics
Medicare: Accepting Medicare Assignments
Practice Location: 12720 Bass Lake Rd, Maple Grove, MN 55369
Phone: 414-266-2000    

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