Elena Rose Cowen Bantle, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

14385 Issued in MN

Practice address

211 S Boundary Ave
Duluth, MN 55810-2306

Phone

(218) 576-0200

NPI assigned

Oct 31, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Elena Rose Bantle Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians

The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Essentia Health Duluth Hospital, Duluth, MN, CCN 240019
• Essentia Health St Mary's Medical Center Hospital, Duluth, MN, CCN 240002

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• The Duluth Clinic LTD

  dba Essentia Health Cloquet Clinic

  • Multi-Specialty Clinic/Center
  • Cloquet, MN
  • NPI 1902563638
  Medicare reassignment Care Compare group
• Polinsky Medical Rehabilitation Center

  dba Essentia Health Polinsky Medical Rehabilitation Center

  • Rehabilitation Clinic/Center
  • Duluth, MN
  • NPI 1639237746
  Care Compare group
• The Duluth Clinic, LTD

  dba Essentia Health West Duluth Clinic

  • Multi-Specialty Clinic/Center
  • Duluth, MN
  • NPI 1669410221
  NPD
• The Duluth Clinic, LTD.

  dba Essentia Health Hinckley Pharmacy

  • Community/Retail Pharmacy
  • Hinckley, MN
  • NPI 1245081066
  NPD
• The Duluth Clinic, LTD

  dba Duluth Clinic

  • Anesthesiology Physician
  • Duluth, MN
  • NPI 1760417935
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Marys Medical Center

  dba Essentia Health St Marys Medical Center

  • General Acute Care Hospital
  • Duluth, MN
  • NPI 1457393035
  Care Compare affiliation
• St. Marys Medical Center

  dba SMMC Life Flight

  • Air Ambulance
  • Duluth, MN
  • NPI 1841359478

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1635638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677801600000",
    "number": "1487318911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S BOUNDARY AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558102306",
            "telephone_number": "218-576-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COWEN BANTLE",
        "first_name": "ELENA",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-31",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELENA",
            "last_name": "BANTLE",
            "middle_name": "ROSE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physician Assistant in Duluth, MN
• Providers in Duluth, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.