NPIMap

Organization Active NPI

Amy R Ellingson MD PA

Doing business as Allergy & Asthma Specialty Clinic

  • Allergy Physician
  • Willmar, MN
National Provider Identifier
1295907152
Registry record updated Mar 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy PhysicianTaxonomy code 207KA0200X
License
1538 Issued in MN
Legal business name
AMY R ELLINGSON MD PA
Doing business as
Allergy & Asthma Specialty Clinic
Practice address
1037 19TH Ave SW
Willmar, MN 56201-5005
Phone
(320) 214-1100
Fax
(320) 214-1155
NPI assigned
Mar 31, 2008
Last updated
Mar 31, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2008

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

Authorized official

Name
Dr. Amy R Ellingson, MDNPI 1417032160
Title
President
Phone
(320) 214-1100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207KA0200X 1538 MN Primary

Addresses

Primary practice location

1037 19TH Ave SW
Willmar, MN 56201-5005

Mailing address

PO Box 1015
Willmar, MN 56201-1015
Phone (320) 214-1100

Other names 1

  • Allergy & Asthma Specialty Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090619000138 MN Part B Supplier - Clinic/Group Practice 3375694094 Receives reassigned benefits from 3 practitioners
Practice locations: Willmar, MN

National Provider Directory

National Provider Directory

Locations

1037 19th Ave SW
Willmar, MN 56201
Phone (320) 214-1100

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206921600000",
    "number": "1295907152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1015",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562011015",
            "telephone_number": "320-214-1100",
            "fax_number": "320-214-1155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1037 19TH AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562015005",
            "telephone_number": "320-214-1100",
            "fax_number": "320-214-1155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMY R ELLINGSON MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-31",
        "last_updated": "2008-03-31",
        "status": "A",
        "authorized_official_last_name": "ELLINGSON",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "320-214-1100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology, Allergy",
            "state": "MN",
            "license": "1538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allergy & Asthma Specialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Willmar, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.