Marcine P Ellwein, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

48447 Issued in MN

Practice address

610 30TH Ave W
Alexandria, MN 56308-3426

Phone

(320) 763-5123

Fax

(320) 763-7883

NPI assigned

Oct 18, 2006

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 identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

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 and National Provider Directory roles.

• Centracare Clinic

  • Multi-Specialty Clinic/Center
  • St Cloud, MN
  • NPI 1043212665
  NPD

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349827200000",
    "number": "1487735379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 30TH AVE W",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563083426",
            "telephone_number": "320-763-5123",
            "fax_number": "320-763-7883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 30TH AVE W",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563083426",
            "telephone_number": "320-763-5123",
            "fax_number": "320-763-7883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLWEIN",
        "first_name": "MARCINE",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2012-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "48447",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "096408000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard D Eiser, M.D.
• Joshua Luther Eken, M.D.
• Ritajo Ellenberger
• David Michael Ellis, CPO
• Tim D Ellison
• Tiffany Marie Emard
• John W Emblom, DO
• Brittany Emons
• Empowered Midwifery and Wellness, LLC
• Resada Kathryn Enberg, PT, DPT, ATC

• Pediatrics Physician in Alexandria, MN
• Providers in Alexandria, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2012; 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.