Mark Stanley Mellstrom, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

27926 Issued in MN

Practice address

701 Hewitt Blvd
Red Wing, MN 55066-2848

Phone

(651) 267-5000

Fax

(651) 267-5964

NPI assigned

Dec 15, 2006

Last updated

Feb 5, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN, WI2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Mayo Clinic

  • Multi-Specialty Clinic/Center
  • Rochester, MN
  • NPI 1922074434
  Medicare reassignment NPD
• Mayo Clinic Health System-Lake City

  • Multi-Specialty Clinic/Center
  • Lake City, MN
  • NPI 1164463659
  Medicare reassignment NPD
• Mayo Clinic Health System-Southeast Minnesota Region

  dba Mayo Clinic Health System-Red Wing

  • Multi-Specialty Clinic/Center
  • Red Wing, MN
  • NPI 1114453883

  WI

  Medicare reassignment NPD
• Mayo Clinic Health System-Southeast Minnesota Region

  dba Mayo Clinic Health System-Albert Lea and Austin

  • Multi-Specialty Clinic/Center
  • Albert Lea, MN
  • NPI 1891701637
  Medicare reassignment NPD
• Mark S Mellstrom MD PA

  dba Lakeville Family Practice

  • Primary Care Clinic/Center
  • Lakeville, MN
  • NPI 1629244686
  NPD Authorized official
• Mark S Mellstrom, MD, PA

  • Family Medicine Physician
  • Lakeville, MN
  • NPI 1639340409
  NPD Authorized official
• Mayo Clinic

  • Clinical Medical Laboratory
  • Rochester, MN
  • NPI 1083249577
  NPD
• Mayo Clinic Health System-Southeast Minnesota Region

  dba Mayo Clinic Health System Pharmacy - Cannon Falls

  • Clinic Pharmacy
  • Cannon Falls, MN
  • NPI 1699597468
  NPD
• Benedictine Care Centers

  • Skilled Nursing Facility
  • Red Wing, MN
  • NPI 1609135003
  NPD (past)
• Fairview Seminary Home

  • Skilled Nursing Facility
  • Red Wing, MN
  • NPI 1255328175
  NPD (past)
• Northfield Hospital

  dba FamilyHealth Medical Clinic of Elko New Market

  • Primary Care Clinic/Center
  • Elko New Market, MN
  • NPI 1437424322
  NPD (past)
• The Evangelical Lutheran Good Samaritan Society

  dba Good Samaritan Society - Albert Lea

  • Skilled Nursing Facility
  • Albert Lea, MN
  • NPI 1659352326
  NPD (past)

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1346302106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "651-267-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 HEWITT BLVD",
            "city": "RED WING",
            "state": "MN",
            "postal_code": "550662848",
            "telephone_number": "651-267-5000",
            "fax_number": "651-267-5964"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20157 Icenic Trl",
            "address_purpose": "LOCATION",
            "city": "Lakeville",
            "state": "MN",
            "postal_code": "550447708",
            "country_code": "US",
            "telephone_number": "952-469-3393",
            "fax_number": "952-469-3399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MELLSTROM",
        "first_name": "MARK",
        "middle_name": "STANLEY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "27926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marla Ellen McConkey, PA-C
• Christopher J McDevitt, M.D.
• Arlie Lynee McLaren, MOTR/L
• Medical Equipment Inc. (Hiawatha Medical Equipment)
• Amy Lynn Meixner, CPRSS
• Jessica Mertins
• Naomi Lynn Mewhorter
• Jacqueline J Meyer-Rostad, DNP, APRN, CNP-C
• Thomas M.G. Meyer, MD
• Midwest Companies, Inc (Midwest Transit)

• Family Medicine Physician in Red Wing, MN
• Providers in Red Wing, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.