Enrico Ocampo, M.D., FACP, FACE
Individual provider Active NPI Endocrinology, Diabetes & Metabolism Physician · Tyler, MN
NPI 1174501159 · NPPES record last updated Sep 13, 2016
Key facts
- NPI
- 1174501159
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endocrinology, Diabetes & Metabolism Physician 207RE0101X
- License
- 38557 (MN)
- Practice address
- 240 Willow St
Tyler, MN 56178-1166 - Phone
- (507) 247-5921
- Fax
- (507) 247-5184
- NPI assigned
- Jan 9, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 25
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Endocrinology
- Education
- Other, 1990
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
- Avera Tyler
Avera Marshall
Practice addresses (Care Compare)
109 E Lake Benton St
Lake Benton, MN 56149-1309
Phone (507) 368-4323
240 Willow St
Tyler, MN 56178-1201
Phone (507) 247-5521
300 S Bruce St
Marshall, MN 56258-1934
Phone (507) 537-9165
Hospital & facility affiliations
- Avera Tyler Hospital
- Avera Marshall Regional Medical Ctr
- Pipestone County Medical Center
- Avera Granite Falls
- Murray County Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111129000362 | MN | Practitioner - Internal Medicine |
3870533359 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38557 | MN | MD | Endocrinology, Diabetes & Metabolism Physician |
| 219031 | NY | MD | Endocrinology, Diabetes & Metabolism Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera Marshall | Current |
Accepting new patients | |
| Avera Granite Falls | Current |
Accepting new patients | |
| Avera Tyler | Current |
Accepting new patients | |
| Avera Granite Falls | Current | Accepting new patients | |
| Avera Marshall | Current | Accepting new patients | |
| Avera Marshall | Current |
Accepting new patients | |
| Avera Tyler | Current | Accepting new patients | |
| Avera Tyler | Current |
Accepting new patients | |
| Booth Medical Associates PC | Endocrinology, Diabetes & Metabolism | Past | Accepting new patients |
| Newyork-Presbyterian/Queens | Past | Accepting new patients |
Locations
250 Jordan Dr
Granite Falls, MN 56241
Phone (320) 522-0723
345 10th Ave
Granite Falls, MN 56241
Phone (320) 564-3111
109 E Benton St
Lake Benton, MN 56149
Phone (507) 368-4323
300 S Bruce St
Marshall, MN 56258
Phone (507) 532-9631
1325 S Cliff Ave
Sioux Falls, SD 57105
Phone (605) 322-5000
1200 S 7th Ave
Sioux Falls, SD 57105
Phone (605) 336-2140
Interoperability endpoints
- enrico.ocampo@avera.sdhealthlink.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endocrinology, Diabetes & Metabolism Physician | 207RE0101X | 219031 | NY | |
| Endocrinology, Diabetes & Metabolism Physician | 207RE0101X | 38557 | MN | Yes |
Addresses
Primary practice location
240 Willow St
Tyler, MN 56178-1166
Mailing address
240 Willow St
Tyler, MN 56178-1166
Phone (507) 247-5921
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4C0736 | Other | NY | PHCS |
| 28P0352 | Other | NY | NY PRESBYTERIAN |
| 166149 | Other | NY | ELDERPLAN |
| P2137433 | Other | NY | OXFORD |
| 133442196 | Other | NY | UNITED HEALTHCARE |
| 133442196 | Other | NY | MAGNACARE |
| 133442196 | Other | NY | 1199 NATIONAL BENEFIT |
| 6235251004 | Other | NY | CIGNA |
| EO08607710 | Other | NY | EMPIRE B/C B/S |
NPI Registry JSON
{
"created_epoch": "1136764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473724800000",
"number": "1174501159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 WILLOW ST",
"city": "TYLER",
"state": "MN",
"postal_code": "561781166",
"telephone_number": "507-247-5921",
"fax_number": "507-247-5184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 WILLOW ST",
"city": "TYLER",
"state": "MN",
"postal_code": "561781166",
"telephone_number": "507-247-5921",
"fax_number": "507-247-5184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OCAMPO",
"first_name": "ENRICO",
"name_prefix": "Dr.",
"credential": "M.D., FACP, FACE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-09",
"last_updated": "2016-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "207RE0101X",
"taxonomy_group": "",
"desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
"state": "NY",
"license": "219031",
"primary": false
},
{
"code": "207RE0101X",
"taxonomy_group": "",
"desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
"state": "MN",
"license": "38557",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS",
"identifier": "4C0736",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NY PRESBYTERIAN",
"identifier": "28P0352",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ELDERPLAN",
"identifier": "166149",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P2137433",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "133442196",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGNACARE",
"identifier": "133442196",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "1199 NATIONAL BENEFIT",
"identifier": "133442196",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "6235251004",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE B/C B/S",
"identifier": "EO08607710",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, MN
- Marcia S Kells
- Richard L Klingler
- Koster Pharmacy
- Lyon-Lincoln Electric Cooperative, Inc.
- Edward B Novak
- Amy Lea Reese
- Christopher Stephen Reynolds
- Michelle Reynolds
- Southwest Family Chiropractic P.L.C.
- Thrifty Drug Stores Inc
All providers in Tyler, MN · Endocrinology, Diabetes & Metabolism Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.