Individual provider Active NPI

Ellen Grace Barnstable, MD

  • Dermatology Physician
  • Lake Geneva, WI
National Provider Identifier
1053948562
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
83862-20 Issued in WI
Practice address
146 E Geneva SQ
Lake Geneva, WI 53147-9695
Phone
(622) 249-5000
NPI assigned
Mar 25, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 11021938A IN
Student in an Organized Health Care Education/Training Program 390200000X
Dermatology Physician 207N00000X 83862-20 WI Primary

Addresses

Primary practice location

146 E Geneva SQ
Lake Geneva, WI 53147-9695

Mailing address

146 E Geneva SQ
Lake Geneva, WI 53147-9695
Phone (622) 249-5000

Other practice location 1

2901 W Oklahoma Ave
Milwaukee, WI 53215-4329
Phone (414) 649-3323

Other practice location 2

545 Barnhill Dr
Indianapolis, IN 46202-5112
Phone (317) 278-6833

Other identifiers 1

IdentifierTypeStateIssuer
100287398MedicaidWI

Other names 1

  • Miss Ellen Grace Wright Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ewright263409@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240918002528 WI Practitioner - Dermatology 9234530353 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
R Franklin University of Med & Sci/Chicago Medical School, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

146 E Geneva SQ
Lake Geneva, WI 53147-9694
Phone (262) 249-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.02 of 100Reported as apm
Quality
85.37
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision15
Removal of skin lesions332
Removal or shaving of skin growth1-10
Skin biopsy243

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Aug 5, 2024 Accepting new patients
Aurora Medical Group, Inc. Current Accepting new patients
Aurora Medical Group, Inc. CurrentSince Aug 5, 2024 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

146 E Geneva Sq
Lake Geneva, WI 53147
Phone (262) 249-4678

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

Interoperability endpoints

  • Direct secure messaging: ewright263409@direct.myadvocateaurora.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1053948562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 E GENEVA SQ",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531479695",
            "telephone_number": "622-249-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 E GENEVA SQ",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531479695",
            "telephone_number": "622-249-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2901 W Oklahoma Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532154329",
            "country_code": "US",
            "telephone_number": "414-649-3323",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "545 Barnhill Dr",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025112",
            "country_code": "US",
            "telephone_number": "317-278-6833",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BARNSTABLE",
        "first_name": "ELLEN",
        "middle_name": "GRACE",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-25",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "11021938A",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WI",
            "license": "83862-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100287398",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ewright263409@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "146 E Geneva Sq",
            "city": "Lake Geneva",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531479695",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "146 E Geneva Sq",
            "city": "Lake Geneva",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531479695",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ELLEN",
            "last_name": "WRIGHT",
            "middle_name": "GRACE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lake Geneva, WI

Sources for this page

Verify at the official NPI Registry.