Active NPI
Amy R Ellingson MD PA
- Allergy Physician
- Willmar, MN
National Provider Identifier
1295907152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy Physician
- License
- 1538
- Legal business name
- AMY R ELLINGSON MD PA
- Practice address
- 1037 19TH Ave SW
Willmar, MN 56201-5005 - Phone
- (320) 214-1100
- Fax
- (320) 214-1155
- NPI assigned
- Mar 31, 2008
- Organization subpart
- No
Authorized official
NPPES NPI Registry- Name
- Dr. Amy R Ellingson, MD
- 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.
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Nurse Practitioner
- Willmar, MN
- NPI 1437234127
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090619000138 | MN | Part B Supplier - Clinic/Group Practice | 3375694094 |
Receives reassigned benefits from 3 practitioners Practice locations: Willmar, MN |
National Provider Directory
National Provider DirectoryLocations
1037 19th Ave SW
Willmar, MN 56201
Phone (320) 214-1100
Specialties & licenses 1
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy Physician | 207KA0200X | 1538 | MN | Primary |
Addresses
NPPES NPI RegistryPrimary 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
NPPES NPI Registry- Allergy & Asthma Specialty Clinic
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 31, 2008.
{
"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.