Ellen L Ketterling, MD – Pediatrics Physician

Key facts

NPI: 1245323930
Entity type: Individual (NPI type 1)
Primary specialty: Pediatrics Physician 208000000X
License: 5100 (ND)
Practice address: 1000 Highway 12
Hettinger, ND 58639
Phone: (701) 567-4561
NPI assigned: Oct 2, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 1

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.

Frances Mahon Deaconess Hospital Critical Access Hospital · Glasgow, MT · NPI 1689685323

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
5100	ND	MD	Pediatrics Physician

Practice roles

Organization	Specialty	Status	New patients
Frances Mahon Deaconess Hospital		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pediatrics Physician	208000000X	5100	ND	Yes

Addresses

Primary practice location

1000 Highway 12
Hettinger, ND 58639

Mailing address

1100 Highway 12
Hettinger, ND 58639-7533
Phone (701) 567-6130

Other identifiers

Identifier	Type	State	Issuer
10782	Other		ND BC/BS
7705170	Medicaid	SD
33921	Other		SIOUX VALLEY
14662	Medicaid	ND

Other providers in Hettinger, ND

All providers in Hettinger, ND · Pediatrics Physician in North Dakota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.