Active NPI
Elissa Chung
- Physician Assistant
- Woodbury, MN
National Provider Identifier
1104338730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 779 Bielenberg Dr Ste 108
Woodbury, MN 55125-4432 - Phone
- (763) 231-8700
- NPI assigned
- Nov 5, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
779 Bielenberg Dr Ste 108
Woodbury, MN 55125-4432
Mailing address
820 Springer Dr
Lombard, IL 60148-6413
Phone (815) 744-8554
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: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
779 Bielenberg Dr
Suite 108
Woodbury, MN 55125-4432
Phone (763) 231-8700
Merit-based Incentive Payment System (MIPS)
- Final score
- 89.8 of 100
- Promoting interoperability
- 88
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12509 | MN | MD | Physical Therapist |
Interoperability endpoints
- elissa.chung@qdp.emadirect.md
Organizations & group practices 2
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.
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- Plymouth, MN
- NPI 1609009380
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1509840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646611200000",
"number": "1104338730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 SPRINGER DR",
"city": "LOMBARD",
"state": "IL",
"postal_code": "601486413",
"telephone_number": "815-744-8554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "779 BIELENBERG DR STE 108",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551254432",
"telephone_number": "763-231-8700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHUNG",
"first_name": "ELISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-05",
"last_updated": "2022-03-07",
"certification_date": "2022-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; 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.