Active NPI
Jonathan W Mellema, MD
- Otolaryngology Physician
- Willmar, MN
National Provider Identifier
1083680458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 47540
- Practice address
- 1801 19TH Ave SW
Willmar, MN 56201-4946 - Phone
- (320) 231-3277
- Fax
- (320) 214-5758
- NPI assigned
- Feb 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 47540 | MN | Primary |
Addresses
Primary practice location
1801 19TH Ave SW
Willmar, MN 56201-4946
Mailing address
1801 19TH Ave SW
Willmar, MN 56201-4946
Phone (320) 231-3277
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 312128300 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050706000707 | MN | Practitioner - Otolaryngology | 6305882861 | Reassigns benefits to 10 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Otolaryngology
- Education
- University of Minnesota Medical School, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Janning ENT Center, LLCAvera Marshall
Practice addresses (Care Compare)
1801 19TH Ave SW
Willmar, MN 56201-4946
Phone (320) 231-3277
300 S Bruce St
Marshall, MN 56258-1934
Phone (507) 537-9165
Hospital & facility affiliations
- Avera Marshall Regional Medical Ctr
- Centracare- Rice Memorial Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Surgery Center, LLC | Current | Accepting new patients | |
| Appleton Area Health | Current | Accepting new patients | |
| Appleton Area Health | Current | Accepting new patients | |
| Madison Healthcare Services | Current | Accepting new patients | |
| Avera Marshall | Current | Accepting new patients | |
| Lac Qui Parle Clinic of Madison Inc | Current | Accepting new patients | |
| Centracare Clinic Southwest LLC | Current | Accepting new patients | |
| Janning ENT Center, LLC | Otolaryngology | Current | Accepting new patients |
| Appleton Area Health | Current | Accepting new patients | |
| Centracare Clinic Southwest LLC | Current | Accepting new patients | |
| Minnesota Pathologists Chartered | Current | Accepting new patients | |
| Family Surgery Center, LLC | Current | Accepting new patients | |
| Carris Health LLC | Current | Accepting new patients | |
| Avera Marshall | Past | Accepting new patients |
Locations
900 2nd Ave
Madison, MN 56256
Phone (320) 598-7536
300 S Bruce St
Marshall, MN 56258
Phone (507) 532-9631
600 Peterson Pkwy
New London, MN 56273
Phone (320) 354-2222
301 Becker Ave SW
Willmar, MN 56201
Phone (320) 231-4120
101 Willmar Ave SW
Willmar, MN 56201
Phone (320) 231-5079
Interoperability endpoints
- jmellema555762@direct.centracare.com
- jonathan.mellema@avera.sdhealthlink.net
Organizations & group practices 26
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.
-
- Multi-Specialty Clinic/Center
- Marshall, MN
- NPI 1962641936
-
- Home Health Agency
- Marshall, MN
- NPI 1033535547
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Marshall, MN
- NPI 1154856839
Hospital & facility affiliations 3
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": "1140998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728518400000",
"number": "1083680458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1801 19TH AVE SW",
"city": "WILLMAR",
"state": "MN",
"postal_code": "562014946",
"telephone_number": "320-231-3277",
"fax_number": "320-214-5758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 19TH AVE SW",
"city": "WILLMAR",
"state": "MN",
"postal_code": "562014946",
"telephone_number": "320-231-3277",
"fax_number": "320-214-5758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELLEMA",
"first_name": "JONATHAN",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-27",
"last_updated": "2024-10-10",
"certification_date": "2024-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "MN",
"license": "47540",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "312128300",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Willmar, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.