Individual provider Active NPI

Herodotos Ellinas, MD

  • Anesthesiology Physician
  • Minneapolis, MN
National Provider Identifier
1306934179
Registry record updated Feb 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
72674 Issued in MN
Practice address
2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone
(612) 273-3000
NPI assigned
Oct 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 41755 WI
Pediatric Anesthesiology Physician 207LP3000X 72674 MN
Pediatric Anesthesiology Physician 207LP3000X 41755 WI
Anesthesiology Physician 207L00000X 72674 MN Primary

Addresses

Primary practice location

2450 Riverside Ave
Minneapolis, MN 55454-1450

Mailing address

420 Delaware St SE
Minneapolis, MN 55455-0341
Phone (612) 273-3000

Other identifiers 2

IdentifierTypeStateIssuer
64320880MedicaidKY
1306934179MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050815000311 WI Practitioner - AnesthesiologyPractitioner - Pediatric MedicinePractitioner - Internal Medicine 3971533522 Reassigns benefits to 1 organization
I20230321000906 MN Practitioner - Anesthesiology 3971533522 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Chicago, Pritzker School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Anesthesia Providers LLCGroup PAC ID 7315986064, 325 clinicians

Practice addresses (Care Compare)

2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone (612) 273-4097

Hospital & facility affiliations

  • M Health Fairview University of MN Medical Center Hospital, Minneapolis, MN, CCN 240080

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41755WIMDAnesthesiology Physician
72674MNMDPediatric Anesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Minnesota Health Clinics and Surgery Center, Inc. Current Accepting new patients
University Anesthesia Providers, LLC Anesthesiology CurrentSince Jan 23, 2023 Accepting new patients
University of Minnesota Health Clinics and Surgery Center Inc Anesthesiology CurrentSince Jan 23, 2023 Accepting new patients
The Medical College of Wisconsin, Inc. Anesthesiology CurrentSince Mar 4, 2010 Accepting new patients
Fairview Clinics Past Accepting new patients
Advanced Healthcare SC Past Accepting new patients
Aurora Advanced Healthcare, Inc. Past Accepting new patients

Locations

14500 99th Ave N
Ste 500
Maple Grove, MN 55369
Phone (763) 898-1400

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

420 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-6483

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625

Organizations & group practices 7

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 3

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": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1306934179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550341",
            "telephone_number": "612-273-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-273-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINAS",
        "first_name": "HERODOTOS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WI",
            "license": "41755",
            "primary": false
        },
        {
            "code": "207LP3000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pediatric Anesthesiology",
            "state": "MN",
            "license": "72674",
            "primary": false
        },
        {
            "code": "207LP3000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pediatric Anesthesiology",
            "state": "WI",
            "license": "41755",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MN",
            "license": "72674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64320880",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306934179",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.