NPIMap

Individual provider Active NPI

Elaine Jayne Catherine Buckley, MD

  • Surgery Physician
  • Saint Paul, MN
National Provider Identifier
1265873681
Registry record updated Jul 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
125.063949 Issued in IL
Practice address
640 Jackson St # Ms 11502V
Saint Paul, MN 55101
Phone
(651) 254-7980
Fax
(651) 254-7990
NPI assigned
Jul 14, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 125.063949 IL Primary

Addresses

Primary practice location

640 Jackson St # Ms 11502V
Saint Paul, MN 55101

Mailing address

8170 33Rd Ave S # Ms 21110Q
Minneapolis, MN 55425-4516
Phone (651) 254-7980

Other practice location 1

701 N 1st St Ste D308
Springfield, IL 62702-3757
Phone (217) 545-4401

Other practice location 2

1500 Duarte Rd
Duarte, CA 91010-3012
Phone (626) 256-4673

Other practice location 3

1500 Duarte Rd
Duarte, CA 91010-3012
Phone (626) 256-4673

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190822002028 MN Practitioner - General Surgery 1052553815 Reassigns benefits to 1 organization
I20251205002672 WA Practitioner - General Surgery 1052553815 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

407 14TH Ave SE
Puyallup, WA 98372-3770
Phone (253) 697-1962

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125.063949ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince Sep 1, 2019 Accepting new patients
Group Health, Inc. CurrentSince Sep 1, 2019 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince Oct 10, 2025 Accepting new patients
Multicare Health System CurrentSince Oct 10, 2025 Accepting new patients
Group Health, Inc. Current Accepting new patients

Locations

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

640 Jackson St
#11502V
Saint Paul, MN 55101
Phone (651) 254-7980

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

315 S K St
Tacoma, WA 98405
Phone (253) 403-1291

Organizations & group practices 6

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.

Hospital & facility affiliations 10

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": "1373760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563753600000",
    "number": "1265873681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554254516",
            "telephone_number": "651-254-7980",
            "fax_number": "651-254-7990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 JACKSON ST # MS 11502V",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "55101",
            "telephone_number": "651-254-7980",
            "fax_number": "651-254-7990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 N 1st St Ste D308",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627023757",
            "country_code": "US",
            "telephone_number": "217-545-4401",
            "fax_number": "217-545-2586",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 Duarte Rd",
            "address_purpose": "LOCATION",
            "city": "Duarte",
            "state": "CA",
            "postal_code": "910103012",
            "country_code": "US",
            "telephone_number": "626-256-4673",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 Duarte Rd",
            "address_purpose": "LOCATION",
            "city": "Duarte",
            "state": "CA",
            "postal_code": "910103012",
            "country_code": "US",
            "telephone_number": "626-256-4673",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "ELAINE JAYNE",
        "middle_name": "CATHERINE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-14",
        "last_updated": "2019-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "125.063949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.