KELLY UNDERBERG JOHNSON CNP
NPI 1114157625
Nurse Practitioner - Family in Duluth, MN
About Kelly Underberg Johnson Cnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY UNDERBERG JOHNSON CNP (NPI 1114157625) is an individual family provider in Duluth, Minnesota, licensed in Minnesota (R 114150-2) and active in the NPI registry since July 2009. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 4
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kelly Underberg Johnson Cnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
3Medicare enrollment records show Kelly Johnson reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Duluth, MN 55805
- Reassigned Medicare billing, Minnesota and Wisconsin enrollments
- 1,460 clinicians in this Medicare group
Superior, WI 54880
- Reassigned Medicare billing, Wisconsin enrollment
- Medicare enrollment name: St Marys Hospital Of Superior
- 381 clinicians in this Medicare group
Brainerd, MN 56401
- Reassigned Medicare billing, Minnesota enrollment
- 127 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 55805 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kelly Johnson's NPI number?
The NPI number for Kelly Johnson is 1114157625. It was assigned to this individual provider in the NPPES registry on July 17, 2009. The provider is also known as Kelly Underberg.
Where is Kelly Johnson located?
Kelly Johnson practices at 400 E 3rd St Smdc Medical Center-Duluth Clinic, Duluth, MN 55805. The listed phone number is (218) 786-3925.
What is Kelly Johnson's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Kelly Johnson enrolled in Medicare?
Yes. Kelly Johnson is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Kelly Johnson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Johnson reassigns Medicare benefits to 3 organizations: The Duluth Clinic, Ltd (Duluth, MN), St. Mary's Hospital Of Superior (Superior, WI) and Brainerd Medical Center Inc (Brainerd, MN). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Johnson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kelly Johnson accept?
Health plans from HealthPartners and Security Health Plan list Kelly Johnson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Kelly Johnson was last updated on June 20, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kelly Underberg Johnson, CNP · NPI 1114157625
Family physician in Duluth, Minnesota. Individual provider, active in the CMS NPPES registry since July 17, 2009.
## Identity
- **NPI:** 1114157625 (Entity type: Individual)
- **Enumerated:** July 17, 2009
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** R 114150-2 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 400 E 3RD ST, SMDC MEDICAL CENTER-DULUTH CLINIC, Duluth, MN 55805-1951
- **Phone:** (218) 786-3925
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): The Duluth Clinic, Ltd (NPI 1245278209, Duluth, MN); St. Mary's Hospital Of Superior (NPI 1083657886, Superior, WI); Brainerd Medical Center Inc (NPI 1295801777, Brainerd, MN) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 20, 2011
- **Other identifiers:** Medicaid 1114157625 (WI); Medicare PIN 50005446 (MN); Medicaid 1114157625 (MN); and 1 more
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Source: [NPI Profile](https://npiprofile.com/npi/1114157625) · Data from the CMS NPPES public registry.