NPIMap

Individual provider Active NPI

Abigail Krin Elliott, MD

  • Family Medicine Physician
  • Waconia, MN
National Provider Identifier
1295180586
Registry record updated Jun 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
62512 Issued in MN
Practice address
424 W State Highway 5
Waconia, MN 55387-1723
Phone
(952) 442-4461
NPI assigned
Apr 25, 2016
Last updated
Jun 7, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 7, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X 62512 MN Primary

Addresses

Primary practice location

424 W State Highway 5
Waconia, MN 55387-1723

Mailing address

424 W State Highway 5
Waconia, MN 55387-1795
Phone (952) 442-4461

Other practice location 1

2500 Como Ave
Saint Paul, MN 55108-1460
Phone (952) 853-8800

Other practice location 2

580 Rice St
Saint Paul, MN 55103-2148
Phone (651) 227-6551

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170814002210 MN Practitioner - Family Practice 2961794680 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeview Clinic, LTD.Group PAC ID 6002801453, 52 clinicians

Practice addresses (Care Compare)

424 W State Hwy 5
Waconia, MN 55387-1723
Phone (952) 442-4461

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Clinics CurrentSince Dec 12, 2017 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Express Care CurrentSince Dec 12, 2017 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Dec 12, 2017 Accepting new patients
Lakeview Clinic, LTD. CurrentSince Jul 31, 2019 Accepting new patients
Fairview Health Services CurrentSince Dec 12, 2017 Accepting new patients
Fairview Express Care CurrentSince Jan 1, 2019 Accepting new patients
Moravian Care Housing Corporation Past Accepting new patients

Locations

13819 Hanson Blvd NW
Andover, MN 55304
Phone (763) 572-5700

110105 Pioneer Trl W
Chaska, MN 55318
Phone (952) 361-5800

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

600 W 98th St
Minneapolis, MN 55420
Phone (952) 881-2651

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

406 Faxon Rd N
Nya, MN 55368
Phone (952) 467-1915

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

580 Rice St
Saint Paul, MN 55103
Phone (651) 227-6551

424 W State Highway 5
Waconia, MN 55387
Phone (952) 442-4461

313 Territorial St E
Watertown, MN 55388
Phone (952) 442-4461

Interoperability endpoints

  • Direct secure messaging: abigailelliott@tv.allscriptsdirect.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Auburn Home in WaconiaWaconia, MN, CCN 245583A Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Dec 10, 2019
Dec 10, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1461542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559865600000",
    "number": "1295180586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 W STATE HIGHWAY 5",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871795",
            "telephone_number": "952-442-4461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 W STATE HIGHWAY 5",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871723",
            "telephone_number": "952-442-4461"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 Como Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551081460",
            "country_code": "US",
            "telephone_number": "952-853-8800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "580 Rice St",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551032148",
            "country_code": "US",
            "telephone_number": "651-227-6551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "ABIGAIL",
        "middle_name": "KRIN",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-25",
        "last_updated": "2019-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "62512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waconia, MN

Sources for this page

Verify at the official NPI Registry.