Basic Information
| Provider Information | |||||||||
| NPI: | 1295701092 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | JANA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 86370 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 6701 S MINNESOTA AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571082591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053226960 | ||||||||
| FaxNumber: | 6053226961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 10/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 5201 | SD | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 46022474343 | 05 | NE | MEDICAID | 147L0JO | 01 | MN | BLUE CROSS | OTHER | 0300306 | 01 | SD | MEDICA | OTHER | 57108B005 | 01 | SD | WPS TRICARE | OTHER | 5900460 | 05 | SD | MEDICAID | 136643200 | 05 | MN | MEDICAID | 147L0JO | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 0575076 | 05 | IA | MEDICAID | 240793 | 01 | SD | MIDLANDS CHOICE | OTHER | 31894 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 407211034720 | 01 | SD | PREFERRED ONE | OTHER | 4996031 | 01 | SD | BLUE CROSS | OTHER | P00369254 | 01 | SD | RR MEDICARE | OTHER | 1908621 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | HP39293 | 01 | SD | HEALTHPLANS | OTHER | 5201 | 01 | SD | DAKOTACARE | OTHER |