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Kyle Johannessen , LPCC

Counselor - Professional β€’ Coon Rapids, MN

Active NPI 1851923445 Individual Practitioner Male Practitioner Accepts Medicare assignment
Practice location in NPPES

9120 Springbrook Dr Nw
Coon Rapids, MN 554335845

Call 6127677222 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

9120 Springbrook Dr Nw

Coon Rapids, MN 554335845

Telephone 6127677222
Other Listings in Public Data

NPPES lists 1 additional practice-address record in Duluth, MN. See the list

Source: CMS NPPES NPI Registry, practice location records; release date unavailable.

CMS Doctors and Clinicians lists 1 group name: Fraser Child And Family Center. See the list

Source: CMS Doctors and Clinicians National Downloadable File, release date unavailable.

Listings do not confirm current availability, employment or a shared ownership network.

Medicare Profile & Education

Source: CMS Doctors and Clinicians National Downloadable File

Graduation Year

2016

Years since graduation

10 years (graduated 2016)

CMS Doctors and Clinicians data list 2016 as the year this clinician finished professional school.

What this does not show: Years since graduation

It is not the number of years in practice, and more years does not mean better care.

Source: CMS Doctors and Clinicians National Downloadable File.

NPI first issued

2020

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Accepts Medicare assignment

CMS data list this clinician as accepting Medicare assignment. This means agreeing to take the Medicare-approved amount as full payment for covered services.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Enrolled in Medicare (PECOS)

Kyle Johannessen has a Medicare enrollment record in PECOS, the CMS system clinicians use to enroll so they can bill Medicare or order services for people with Medicare.

It does not show whether the clinician accepts assignment, is in your plan's network, or is taking new patients.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What Medicare enrollment (PECOS) means

Can order Medicare-covered services

CMS lists Kyle Johannessen as eligible to order or refer Medicare Part B clinical laboratory and imaging services and durable medical equipment (DME) for people with Medicare.

What this does not show: Can order Medicare-covered services

It does not mean the clinician offers these services directly.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What ordering and referring status means

Compared with the same specialty in Coon Rapids and Minnesota

31 active clinicians are listed under Counselor - Professional with a practice address in Coon Rapids, MN (2,407 in Minnesota).

Addresses are self-reported to NPPES and may be out of date.

Telehealth indicator in Coon Rapids

19.4% of these 31 clinicians have the CMS telehealth indicator.

54.8% of these 31 clinicians are listed by CMS as accepting Medicare assignment.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2024-09-05
Counselor - Professional Primary Specialty

NUCC Taxonomy Code: 101YP2500X

License # reported to NPPES MN CC02342
Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Minnesota Board of Medical Practice.
Look Up on State Board Site

Medicare (PECOS) Enrollment & Ordering Eligibility

Source: CMS PECOS
Medicare FFS Enrollment Status Medicare Enrollment on File
CMS Provider Specialty

PRACTITIONER - MENTAL HEALTH COUNSELOR

Medicare Enrollment ID

I20240918001218

Enrollment State Jurisdiction

MN

PECOS Control ID

3274074299

Medicare Order & Referring Eligibility
Clinical Lab & Imaging (Part B) Eligible
Durable Medical Equipment (DME) Eligible
Home Health Agency (HHA) Not Eligible
Power Mobility Devices (PMD) Not Eligible

Sources: CMS Provider Enrollment and Order and Referring. Medicare enrollment is a billing status, not an accreditation or quality rating.

Medicare Group Practice Enrollments

Source: CMS Doctors and Clinicians National Downloadable File

Fraser Child And Family Center

2400 W 64th St, Richfield, MN 554231001

Phone: 6128611688

Fraser Child And Family Center

9120 Springbrook Dr Nw, Coon Rapids, MN 554335845

Phone: 6127677222

Secondary Practice Locations

4849 Ivanhoe St

Duluth, MN 558041131

Phone: 2187287418

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

8 Historical Events
πŸ“
Updated Practice Location September 05, 2024

Registered at 9120 SPRINGBROOK DR NW, COON RAPIDS, MN 554335845 (Tel: 6127677222)

πŸ“
Updated Business Mailing Address September 05, 2024

Registered at 9120 SPRINGBROOK DR NW, COON RAPIDS, MN 554335845 (Tel: 6127677222)

βœ…
NPI Profile Active February 11, 2020

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) February 11, 2020

Registered at 4849 IVANHOE ST, DULUTH, MN 558041131 (Tel: 2187287418)

πŸ“
Business Mailing Address (Initial Record) February 11, 2020

Registered at 4321 ALLENDALE AVE, DULUTH, MN 558031562 (Tel: 2187287500)

πŸ‘€
Provider Name / Credentials (Initial Record) February 11, 2020

Recorded as KYLE JOHANNESSEN, LPCC

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) February 11, 2020

Counselor (license number reported to NPPES: MN CC02342)

🟒
Initial NPI Registration & Enumeration February 11, 2020

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1851923445
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: February 11, 2020
Last Update: September 05, 2024
Sole Proprietor: No

Mailing Address

9120 Springbrook Dr Nw

Coon Rapids, MN 554335845

Phone: 6127677222

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.