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SAMANTHA ANN PRUITT-JOHNSON
NPI 1750987749
Counselor - Mental Health in St Louis Park, MN

Active since December 07, 2020PECOS Enrolled
3800 PARK NICOLLET BLVD, ST LOUIS PARK, MN 55416(952) 993-2498(952) 993-2505 Get Directions Write a Review

NPPES record last updated: June 29, 2022. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: May 11, 2022, Dec 7, 2020 (2 updates tracked since 2020).

About Samantha Ann Pruitt-johnson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAMANTHA ANN PRUITT-JOHNSON (NPI 1750987749) is an individual mental health provider in St Louis Park, Minnesota and active in the NPI registry since December 2020. She is enrolled in Medicare PECOS and maintains a secondary practice location in Eagan.

NPPES Registry Identity

NPI1750987749
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameSAMANTHA ANN PRUITT-JOHNSON
Location Address3800 PARK NICOLLET BLVDSt Louis Park, MN 55416-2527
Mailing Address8170 33rd Ave S # Ms 21110qBloomington, MN 55425-4516
Phone(952) 993-2498
Fax(952) 993-2505
Sole ProprietorNo
Enumeration DateDecember 7, 2020
Last NPPES UpdateJune 29, 20222 updates tracked since enumeration
NPPES CertifiedJune 29, 2022
✔ NPI 1750987749 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
3800 PARK NICOLLET BLVD, St Louis Park, MN 55416
Open in Google Maps ↗

Secondary Practice Location 1

Location 12030 Rahn WayEagan, MN 55122-2300 · Phone (651) 529-1960

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners, Medica.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samantha Ann Pruitt-johnson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Samantha Pruitt-johnson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Park Nicollet Clinic
Same address
Family Medicine
3800 PARK NICOLLET BLVD
St Louis Park, MN 55416
  • Reassigned Medicare billing, Minnesota enrollment
  • 2,527 clinicians in this Medicare group
NPI 1063897593 (952) 993-3123

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

PETER MCCORMICK SCHAUB PSYD, LP
Psychologist
3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416
Hennepin County (952) 993-3123
DAVID J NUTZ MD
Physical Medicine & Rehabilitation
3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416
Hennepin County (952) 993-3800
GLENN MATFIN M.D.
Internal Medicine (Endocrinology, Diabetes & Metabolism)
3800 PARK NICOLLET BLVD
MINNEAPOLIS, MN 55416
Hennepin County (952) 993-3048
KELLY C GRECO PAC
Physician Assistant
3800 PARK NICOLLET BLVD, DEPARTMENT OF DERMATOLOGY
ST LOUIS PARK, MN 55416
Hennepin County (952) 993-3260
KARLA SUSAN ROSENMAN MD
Dermatology
3800 PARK NICOLLET BLVD, DERMATOLOGY 4TH FLOOR
ST LOUIS PARK, MN 55416
Hennepin County (952) 993-3821
DR. KRISTIN A KUNZMAN PSY.D.
Psychologist (Clinical)
3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416
Hennepin County (952) 993-3393
DR. ALISON M LANG M.D.
Dermatology
3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416
Hennepin County (952) 993-3789
DR. CHUNG M LEE M.D.
Radiology (Diagnostic Radiology)
3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416
Hennepin County (952) 993-3212

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 Samantha Pruitt-johnson's NPI number?

The NPI number for Samantha Pruitt-johnson is 1750987749. It was assigned to this individual provider in the NPPES registry on December 7, 2020.

Where is Samantha Pruitt-johnson located?

Samantha Pruitt-johnson practices at 3800 Park Nicollet Blvd, St Louis Park, MN 55416. The listed phone number is (952) 993-2498.

What is Samantha Pruitt-johnson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Samantha Pruitt-johnson enrolled in Medicare?

Yes. Samantha Pruitt-johnson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Samantha Pruitt-johnson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Samantha Pruitt-johnson reassigns Medicare benefits to Park Nicollet Clinic (St Louis Park, MN). The 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 Samantha Pruitt-johnson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Samantha Pruitt-johnson accept?

Health plans from HealthPartners and Medica list Samantha Pruitt-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 Samantha Pruitt-johnson was last updated on June 29, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.