SAMUEL JOHNSON – Physician Assistant, NPI 1558740803
Physician Assistant
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,031 PHYSICIAN ASSISTANT in MN
Provider Addresses for SAMUEL JOHNSON
2901 METRO DRIVE
SUITE 527
BLOOMINGTON, MN 55122
Phone: (952) 883-5881
Type: Location
2901 Metro Drive
Suite 527
Bloomington, MN 55122
Phone: (952) 883-5881
Type: Location
2500 Como Ave
Saint Paul, MN 551081460
Phone: (952) 853-8800
Type: Location
535 Hospital Rd
New Richmond, WI 540171449
Phone: (715) 243-2600
Type: Location
3930 Northwoods Dr
Arden Hills, MN 551126963
Phone: (952) 853-8800
Type: Location
15290 Pennock Ln
Apple Valley, MN 551247163
Phone: (952) 853-8800
Type: Location
205 Wabasha St S
Saint Paul, MN 551071805
Phone: (952) 853-8800
Type: Location
265 Griffin St E
Amery, WI 540011439
Phone: (715) 268-8000
Type: Location
8450 Seasons Pkwy
Woodbury, MN 551254402
Phone: (952) 853-8800
Type: Location
N2497 STATE ROAD 58
MAUSTON, WI 53948
Phone: (678) 200-3731
Type: Mailing
1500 CURVE CREST BLVD W
STILLWATER, MN 550826040
Phone: (651) 439-1234
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-10-06
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20150604000445 | I | Physician Assistant | MN | TBD |
| I20231006001173 | I | Physician Assistant | WI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 283 | 266 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 105 | 103 | $0 |
| 71046 | X-ray of chest, 2 views | 58 | 58 | $0 |
| 36415 | Insertion of needle into vein for collection of blood sample | 51 | 50 | $0 |
| 93000 | Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report | 28 | 28 | $0 |
Insurance plans in this area (ZIP 55122)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MN | |
| Clinical Psychologist | MN | |
| - | MN | |
| P S Y C H I A T R Y | MN | |
| Family Practice | MN | |
| - | MN | |
| - | MN | |
| P O D I A T R Y | MN | |
| Physician Assistant | MN | |
| Physician Assistant | MN |
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