Gary Earl Ellwein, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

M3265 Issued in ID

Practice address

3100 Channing Way
Idaho Falls, ID 83404-7533

Phone

(208) 529-6050

Fax

(208) 529-7085

NPI assigned

Mar 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Pathology Associates of Idaho Falls P a

  • Anatomic Pathology & Clinical Pathology Physician
  • Idaho Falls, ID
  • NPI 1497723241
  NPD

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356566400000",
    "number": "1063480804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 E 17TH ST",
            "address_2": "STE 230",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046521",
            "telephone_number": "208-529-9779",
            "fax_number": "208-542-2756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047533",
            "telephone_number": "208-529-6050",
            "fax_number": "208-529-7085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLWEIN",
        "first_name": "GARY",
        "middle_name": "EARL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2012-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "ID",
            "license": "M3265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003682000",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD OF ID",
            "identifier": "000010003940",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "32625",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alisa Ellis, LCPC
• Jay T Ellis, PT, DPT, CSCS
• Josie Ellis
• Shelby Lyn Ellis
• Brent Angel Ellsworth, PA-C
• Louis Davis Ellwood
• Michele Marie Elsbree, LMSW
• Marie L Elser, LMSW
• Emergency Orthopedic Services of Idaho PLLC
• Brenda Emery, CPRP

• Anatomic Pathology & Clinical Pathology Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Anatomic Pathology & Clinical Pathology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.